新辅助免疫联合化疗后非病理完全缓解的非小细胞肺癌患者的辅助强化治疗策略OA

Neoadjuvant immunotherapy combined with chemotherapy(NICT)has become a standard treatment modality for patients with resectable non-small cell lung cancer(NSCLC).However,approximately 80％of patients still have residual disease(non-pathological complete response,non-pCR)after surgery.These patients exhibit significantly poorer long-term survival compared with those achieving pCR,with a 5-year overall survival rate of approximately 55％,representing a major challenge in current perioperative therapy.Drawing on the successful experience of implementing adjuvant intensification strategies(e.g.,ado-trastuzumab emtansine and capecitabine)for non-pCR patients in breast cancer,this article explores the optimization of adjuvant treatment strategies for the non-pCR population following NICT in NSCLC.We focus on analyzing various promising adjuvant intensification approaches,including anti-angiogenic agents,antibody-drug conjugates(ADCs),bispecific antibodies(BsAbs),personalized neoantigen vaccines,radiotherapy,and oral chemotherapy agents,aiming to eradicate drug-resistant residual tumor clones.Furthermore,we propose that fine-grained risk stratification based on the residual viable tumor(RVT)proportion and dynamic monitoring of molecular residual disease(MRD)should be implemented.Establishing a risk-adaptive model integrating RVT and MRD status holds promise for achieving an individualized adjuvant intensification strategy,with the goal of improving survival outcomes for non-pCR NSCLC patients.This review provides a theoretical basis and future research directions for adjuvant intensification in patients with non-pCR NSCLC.