PDF(Pubmed)
Abstract：
BACKGROUND: The advent of immune checkpoint inhibitors has dramatically changed the treatment paradigm for advanced non-small-cell lung cancer (NSCLC). Due to the complexity and diversity of stage III disease, the inclusion of immune checkpoint inhibitors (ICIs) in neoadjuvant treatment regimens is also required. However, immune-related adverse events (irAEs) limit the application of ICIs to a certain extent. Bronchopleural fistula (BPF) is a serious and fatal complication after pneumonectomy that is rarely reported, especially in patients who accept neoadjuvant immunotherapy or chemoimmunotherapy.
METHODS: Herein, we reported four patients with postoperative BPF who received a neoadjuvant regimen of sintilimab plus chemotherapy. Postoperative BPF occurred in the late stage in three patients; one patient underwent bronchoscopic fistula repair, and the fistula was closed well after surgery, and the other two patients gradually recovered within 1-2 months after symptomatic treatment with antibiotics. One patient with BPF after left pneumonectomy died of respiratory failure due to pulmonary infection. We also reviewed the literature on the development of postoperative BPF in patients receiving immuno-neoadjuvant therapy to discuss the clinical process further, postoperative pathological changes, as well as risk factors of BPF patients.
CONCLUSIONS: Central type lung cancer with stage III may be the risk factors of BPF in cases of neoadjuvant immunochemotherapy for lung cancers patients.
METHODS: Herein, we reported four patients with postoperative BPF who received a neoadjuvant regimen of sintilimab plus chemotherapy. Postoperative BPF occurred in the late stage in three patients; one patient underwent bronchoscopic fistula repair, and the fistula was closed well after surgery, and the other two patients gradually recovered within 1-2 months after symptomatic treatment with antibiotics. One patient with BPF after left pneumonectomy died of respiratory failure due to pulmonary infection. We also reviewed the literature on the development of postoperative BPF in patients receiving immuno-neoadjuvant therapy to discuss the clinical process further, postoperative pathological changes, as well as risk factors of BPF patients.
CONCLUSIONS: Central type lung cancer with stage III may be the risk factors of BPF in cases of neoadjuvant immunochemotherapy for lung cancers patients.
摘要：
背景：免疫检查点抑制剂的出现极大地改变了晚期非小细胞肺癌（NSCLC）的治疗模式。由于III期疾病的复杂性和多样性,还需要在新辅助治疗方案中加入免疫检查点抑制剂(ICIs).然而,免疫相关不良事件(irAEs)在一定程度上限制了ICIs的应用。支气管胸膜瘘（BPF）是肺切除术后的严重和致命的并发症，很少报道。尤其是接受新辅助免疫疗法或化学免疫疗法的患者。
方法：这里，我们报道了4例BPF术后患者接受了sintilimab联合化疗的新辅助方案.3例患者术后晚期发生BPF；1例患者行支气管镜瘘修补术，瘘管在手术后很好地闭合，另外两名患者在抗生素对症治疗后1-2个月内逐渐恢复。左肺切除术后的一名BPF患者因肺部感染而死于呼吸衰竭。我们还回顾了有关接受免疫新辅助治疗的患者术后BPF的发展的文献，以进一步讨论其临床过程。术后病理变化，以及BPF患者的危险因素。
结论：Ⅲ期中央型肺癌可能是肺癌患者新辅助化疗后BPF的危险因素。
方法：这里，我们报道了4例BPF术后患者接受了sintilimab联合化疗的新辅助方案.3例患者术后晚期发生BPF；1例患者行支气管镜瘘修补术，瘘管在手术后很好地闭合，另外两名患者在抗生素对症治疗后1-2个月内逐渐恢复。左肺切除术后的一名BPF患者因肺部感染而死于呼吸衰竭。我们还回顾了有关接受免疫新辅助治疗的患者术后BPF的发展的文献，以进一步讨论其临床过程。术后病理变化，以及BPF患者的危险因素。
结论：Ⅲ期中央型肺癌可能是肺癌患者新辅助化疗后BPF的危险因素。
