| 11 | 0 | 6 |
| 下载次数 | 被引频次 | 阅读次数 |
目的 分析微小残留病灶(MRD)在不可切除局部晚期非小细胞肺癌(NSCLC)中的应用价值。方法 纳入经组织病理学确诊的ⅢA～ⅢC期不可切除的NSCLC患者38例，针对接受根治性治疗后疾病未发生进展的患者进行MRD检测。根据MRD检测结果分为MRD阳性组20例和MRD阴性组18例，比较两组5年无进展生存率(PFS)。分别将MRD阳性组和MRD阴性组根据后续是否接受免疫药物巩固治疗，分为未接受巩固治疗亚组和接受巩固治疗亚组，评估MRD状态对巩固治疗疗效的影响。结果 MRD阴性组和MRD阳性组中位PFS差异有统计学差异(P<0.05)。MRD阴性组后续接受免疫巩固治疗和未接受免疫巩固治疗患者PFS无统计学差异(P>0.05);MRD阳性组中两个亚组中位PFS有统计学差异(P>0.05)。结论 不可切除的局部晚期NSCLC根治性治疗后，MRD监测可有效进行预后分层；MRD阴性患者免疫巩固治疗不能带来额外的生存获益，而MRD阳性患者免疫巩固治疗具有潜在生存获益。针对局部晚期不可切除的NSCLC患者，MRD监测可以优化免疫巩固治疗策略，有助于指导个体化免疫巩固治疗。
Abstract：1 Filho AM,Laversanne M,Ferlay J,et al.The Globocan 2022 cancer estimates:data sources,methods,and a snapshot of the cancer burden worldwide[J].Int J Cancer,2025;156(7):1336-46.
2 Aupérin A,Le Péchoux C,Rolland E,et al.Meta-analysis of concomitant versus sequential radiochemotherapy in locally advanced non-small-cell lung cancer[J].J Clin Oncol,2010;28(13):2181-90.
3 Antonia SJ,Villegas A,Daniel D,et al.Durvalumab after chemoradiotherapy in stage Ⅲ non-small-cell lung cancer[J].N Engl J Med,2017;377(20):1919-29.
4 Zhou Q,Chen M,Jiang O,et al.Sugemalimab versus placebo after concurrent or sequential chemoradiotherapy in patients with locally advanced,unresectable,stage Ⅲ non-small-cell lung cancer in China(GEMSTONE-301):interim results of a randomised,double-blind,multicentre,phase 3 trial[J].Lancet Oncol,2022;23(2):209-19.
5 Spigel DR,Faivre-Finn C,Gray JE,et al.Five-year survival outcomes from the PACIFIC trial:durvalumab after chemoradiotherapy in stage Ⅲ non-small-cell lung cancer[J].J Clin Oncol,2022;40(12):1301-11.
6 Abbosh C,Frankell AM,Harrison T,et al.Tracking early lung cancer metastatic dissemination in TRACERx using ctDNA[J].Nature,2023;616(7957):553-62.
7 Li N,Wang BX,Li J,et al.Perioperative circulating tumor DNA as a potential prognostic marker for operable stage Ⅰ to ⅢA non-small cell lung cancer[J].Cancer,2022;128(4):708-18.
8 Qiu B,Guo W,Zhang F,et al.Dynamic recurrence risk and adjuvant chemotherapy benefit prediction by ctDNA in resected NSCLC[J].Nat Commun,2021;12(1):6770.
9 Zhang X,Zhang Y,Zhang S,et al.Investigate the application of postoperative ctDNA-based molecular residual disease detection in monitoring tumor recurrence in patients with non-small cell lung cancer-a retrospective study of ctDNA[J].Front Oncol,2023;13:1098128.
10 Chen K,Yang F,Shen H,et al.Individualized tumorinformed circulating tumor DNA analysis for postoperative monitoring of non-small cell lung cancer[J].Cancer Cell,2023,41(10):1749-62.
11 Zhou Q,Pan Y,Yang X,et al.Neoadjuvant SHR-1701 with or without chemotherapy in unresectable stage Ⅲ non-small-cell lung cancer:a proof-of-concept,phase 2 trial[J].Cancer Cell,2024;42(7):1258-67.
12 Zeng L,Yan H,Jiang W,et al.Toripalimab plus platinum-doublet chemotherapy as perioperative therapy for initially unresectable NSCLC:an open-label,phase 2 trial[J].Med,2025;6(6):100574.
13 Yi C,Bian D,Wang J,et al.Anti-PD1 based precision induction therapy in unresectable stage Ⅲ non-small cell lung cancer:a phase Ⅱ umbrella clinical trial[J].Nat Commun,2025;16(1):1932.
14 Xia H,Zhang H,Ruan Z,et al.Neoadjuvant camrelizumab(an anti-PD-1 antibody) plus chemotherapy or apatinib(a VEGFR-2 inhibitor) for initially unresectable stage Ⅱ-Ⅲ non-small-cell lung cancer:a multicentre,two-arm,phase 2 exploratory study[J].Signal Transduct Target Ther,2024;9(1):145.
15 Yang Y,Zhang T,Wang J,et al.The clinical utility of dynamic ctDNA monitoring in inoperable localized NSCLC patients[J].Mol Cancer,2022;21(1):117.
16 Moding EJ,Liu Y,Nabet BY,et al.Circulating tumor DNA dynamics predict benefit from consolidation immunotherapy in locally advanced non-small cell lung cancer[J].Nat Cancer,2020;1(2):176-83.
17 Pan Y,Zhang JT,Gao X,et al.Dynamic circulating tumor DNA during chemoradiotherapy predicts clinical outcomes for locally advanced non-small cell lung cancer patients[J].Cancer Cell,2023;41(10):1763-73.
18 Dong Q,Chen C,Hu Y,et al.Clinical application of molecular residual disease detection by circulation tumor DNA in solid cancers and a comparison of technologies:review article[J].Cancer Biol Ther,2023;24(1):2274123.
19 Martínez-Castedo B,Camblor DG,Martín-Arana J,et al.Minimal residual disease in colorectal cancer.Tumor-informed versus tumor-agnostic approaches:unraveling the optimal strategy[J].Ann Oncol,2025;36(3):263-76.
20 Chae YK,Oh MS.Detection of minimal residual disease using ctDNA in lung cancer:current evidence and future directions[J].J Thorac Oncol,2019;14(1):16-24.
21 Pantel K,Alix-Panabières C.Liquid biopsy and minimal residual disease-latest advances and implications for cure[J].Nat Rev Clin Oncol,2019;16(7):409-24.
22 Chaudhuri AA,Chabon JJ,Lovejoy AF,et al.Early detection of molecular residual disease in localized lung cancer by circulating tumor DNA profiling[J].Cancer Discov,2017;7(12):1394-403.
23 Zhang JT,Liu SY,Gao W,et al.Longitudinal undetectable molecular residual disease defines potentially cured population in localized non-small cell lung cancer[J].Cancer Discov,2022;12(7):1690-701.
24 Dong S,Wang Z,Zhang JT,et al.Circulating tumor DNA-guided de-escalation targeted therapy for advanced non-small cell lung cancer:a nonrandomized controlled trial[J].JAMA Oncol,2024;10(7):932-40.
基本信息:
中图分类号:R734.2
引用信息:
[1]吴春娇,张良,李慧,等.MRD监测在不可切除局部晚期NSCLC中的应用价值[J].中国老年学杂志,2026,46(06):989-993.
基金信息:
吉林省科技发展计划重点研发项目(20230203062SF)