Curative Effect Of Neoadjuvant Chemo-immunotherapy In Locally Advanced Lung Squamous Cell Carcinoma

Objective:The purpose is to compare the safety and efficacy between neoadjuvant Chemo-immunotherapy and neoadjuvant chemotherapy in locally advanced lung squamous cell carcinoma.Method:The research retrospectively analyzed 48 patients with neoadjuvant treatment in the Second Hospital of Jilin University from September 2019 to February 2022.Twenty-one patients of the observation group were treated with programmed cell death receptor 1 inhibitor（Camrelizumab,Cam）combined with paclitaxel and nedaplatin.The number of male patients and female patients were nineteen and two respectively and the median age are 59.Twenty-seven patients in the control group were treated with paclitaxel and nedaplatin.The number of male patients and female patients were twenty-three and four respectively and the median age are 62.After two cycles of treatment which lasted 21 days,the outcome of treatment was collected to assess the possibility of surgery.The general clinical data were collected such as gender,age,height and so on.The laboratory data was collected including levels of inflammatory factors（NLR and PLR）before and after treatment,levels of lung tumor related markers before and after treatment,Imaging and pathology data,imaging clinical efficacy,major pathological remission（MPR）,and complete pathological remission（p CR）.Perioperative data was collected including incidence of adverse reactions,time from the end of the last chemotherapy to the beginning of surgery（TTS）,the incidence of surgical resection,duration of surgery,intraoperative bleeding,Indwelling time of thoracic drainage tube,and pleural effusion drainage on the first,second and third day after operation.SPSS 23 software was used for statistical analysis.The comparison of influencing factors between the two groups were analyzed by t-test,Wilconxon rank sum test,Chi-square test,or Fisher’s precision probability test.Univariate analysis and binary logistic regression analysis were used to explore independent risk factors for MPR.P≤0.05 was considered statistically significant.Result:The difference in general data between neoadjuvant Chemo-Immunotherapy group and neoadjuvant chemotherapy group was not significant（P> 0.05）.In observation group,the MPR was 76.9%（10）,which was higher than MPR（33.3%）of the control group with the statistical difference（P=0.047）.After treatment,the NLR and PLR of the observation group were 1.74（1.32,2.31）and 122（96.54,155.34）,which were lower than those of the control group.The difference was statistically significant（P=0.034,P=0.033）.In terms of imaging efficacy,CR（4.8%）,PR（52.4%）,and ORR（57.2%）in the observed group were higher than CR（3.7%）,PR（51.9%）,and ORR（55.6%）in the control group.The treatment-related adverse reactions（TRAEs）of observed group were as follows: nine patients had leukopenia,eleven patients had anemia,six patients had thrombocytopenia,eight patients had vomiting after treatment,ten patients had elevated alanine aminotransferase,eleven patients had elevated aspartate aminotransferase,seven patients had diarrhea and eight patients had erythra.The incidence of TRAEs in the observation group was higher than that in the control group,and the difference in the rate of erythra was statistically significant（P=0.025）.The incidence of surgical resection in the observed group was 61.9%,which was higher than control group（44.4%）.In observed group,the duration from the end of the last chemotherapy to operation（TTS）was 31.38±6.46 days.The mean blood loss was 160（110,200）ml.The thoracic drainage tube indwelling time was 6（5,7.5）days.The thoracic effusion drainage was 538.88±152.59 ml on the first day,361.11±50.85 ml on the second day,and 308.89±66.6ml on the third day.The above aspects were higher than those in the control group,which were not statistically significant.BMI,CEA,TNM stage and therapeutic schedule were related to MPR（P<0.2）,after univariate analysis.The results showed that therapeutic schedule was independent risk factors affecting MPR（P<0.05）when BMI,CEA,TNM stage and therapeutic schedule were included in binary logistic regression analysis.Conclusion:1.Neoadjuvant chemo-immunotherapy was effective in the treatment of locally advanced squamous cell lung cancer（ⅢA-ⅢB）.It can significantly improve the incidence of pathological remission and decrease neutrophil/lymphocyte ratio,platelet/lymphocyte ratio and the numerical value of SCC,CEA and CYFRA 21-1.2.The neoadjuvant chemo-immunotherapy group had a high incidence of treatment-related adverse reactions,but no death or serious adverse events occurred;the duration of operation was lower than that of chemotherapy alone group;neoadjuvant combination therapy was safe and feasible to a certain extent.3.Neoadjuvant therapy in the present study was an independent risk factor for MPR.Neoadjuvant chemo-immunotherapy can increase the incidence of major pathological remission.