Title:Effect of Neoadjuvant Immunotherapy Combined with Chemotherapy on
Pulmonary Function and Postoperative Pulmonary Complications in
Esophageal Cancer: A Retrospective Study
Volume: 24
Issue: 10
Author(s): Yongyin Gao, Hongdian Zhang, Yanli Qiu, Xueyan Bian, Xue Wang and Yue Li*
Affiliation:
- Department of Cardio-pulmonary Functions, Tianjin Medical University Cancer Institute and Hospital, National Clinical
Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
Keywords:
Esophageal cancer, NICT, surgery, pulmonary function, pulmonary complications, acute lung injury.
Abstract:
Background: Neoadjuvant immunotherapy, targeting the PD-1 or PD-L1, combined
with chemotherapy (NICT), can improve the radical resection and survival rates for locally advanced
EC. However, it may impair pulmonary function, and the effect of NICT on pulmonary
function and postoperative pulmonary complications in EC patients remains unknown. This study
aimed to investigate whether NICT can affect pulmonary functions and postoperative pulmonary
complications in EC patients.
Methods: The study retrospectively recruited 220 EC patients who received NICT at the Department
of Esophageal Cancer in Tianjin Medical University Cancer Institute & Hospital from January
2021 to June 2022. Changes in pulmonary function before and after NICT were compared.
Logistic regression analysis was performed to analyze the correlations of pulmonary functions and
clinical characteristics with postoperative pulmonary complications, respectively.
Results: The FEV1% pred, FVC, FVC% pred, and FEV1/FVC% significantly increased after
NICT, with a P-value of 0.018, 0.005, 0.001, and 0.036, respectively. In contrast, there was a significant
decline in the DLCO (8.92 ± 2.34 L before NICT vs. 7.79 ± 2.30 L after NICT; P < 0.05)
and DLCO% pred (102.97 ± 26.22% before NICT vs. 90.18 ± 25.04% after NICT; P < 0.05).
High DLCO and DLCO% pred at baseline levels were risk factors for DLCO reduction in EC patients
after NICT. Advanced age, smoking history, FEV1% pred after NICT, and FVC% pred baseline
and after therapy were risk factors for postoperative pulmonary complications, with a P-value
of 0.043, 0.038, 0.048, 0.034, and 0.004, respectively. Although the DLCO level decreased after
NICT, it did not increase the incidence of postoperative pulmonary complications.
Conclusion: NICT may improve pulmonary ventilation function but also lead to a decrease in DLCO
and DLCO% pred in EC patients. Nevertheless, the decreased DLCO after NICT did not increase
the risk of postoperative pulmonary complications.
