免疫チェックポイント阻害薬併用全身化学療法後に管状切除を行った右上葉非小細胞肺癌

Sleeve Resection for Right Upper Lobe Non-small Cell Lung Cancer After Systemic Chemotherapy and Immune Checkpoint Inhibitor Administration

臨床病期ⅢA期の非小細胞肺癌に対して，以前より術前プラチナ併用化学療法の有用性が示されてきた1）が，Fordeらはプラチナ併用化学療法に免疫チェックポイント阻害薬を併用することで，著明な病理学的奏効と無イベント奏効期間の延長が得られたと報告2）し，大きな注目を集めている．

A man in his 50s was diagnosed with right upper lobe non-small-cell lung cancer （cT3N1M0, stage ⅢA） on bronchoscopy. The tumor was located at the right hilum and was bordered extensively on the pulmonary artery. We observed significant tumor shrinkage （ycT1bN1M0, stage ⅡB）, following three cycles of systemic chemotherapy combined with an immune checkpoint inhibitor and performed right upper sleeve lobectomy ＋ ND2a-2 via thoracotomy for radical resection. Postoperative histopathological examination showed no residual tumor cells, and the patient was deemed to have a histopathologic complete response. Currently, the patient is being followed up without adjuvant chemotherapy. Several recent studies have reported the usefulness of systemic chemotherapy combined with immune checkpoint inhibitor administration as preoperative induction chemotherapy. However, the role of adjuvant immunotherapy in patients with a histopathologic complete response remains unclear, and careful treatment decision-making is important.