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Perioperative Therapy / 围手术期治疗
Perioperative Therapy in Oncology
Perioperative therapy is treatment around surgery. In oncology trials, it often combines systemic therapy before surgery with treatment after surgery. The goals may include improving the chance of resection, addressing microscopic disease, and reducing recurrence.
| Treatment | Timing | Common trial endpoints |
|---|---|---|
| Neoadjuvant | Before surgery | pCR, MPR, resection rate |
| Adjuvant | After surgery | DFS, RFS, OS |
| Perioperative | Across the surgical pathway | EFS, OS, pCR, MPR |
KEYNOTE-671 example. In resectable non-small-cell lung cancer, the experimental group received pembrolizumab plus cisplatin-based chemotherapy before surgery, followed by resection and adjuvant pembrolizumab.
How to read the result. The trial compared the full perioperative strategy with its control. An EFS or OS benefit estimates the effect of that strategy. Quantifying the incremental benefit of postoperative immunotherapy requires a design that isolates that treatment phase.
Endpoint glossary. pCR = pathological complete response. MPR = major pathological response, often defined as no more than 10% residual viable tumor, subject to study criteria. EFS = event-free survival, with events defined by the protocol. DFS = disease-free survival. RFS = recurrence-free survival. OS = overall survival.
肿瘤学中的围手术期治疗
围手术期治疗是围绕手术开展的治疗。在肿瘤临床试验中，通常包括术前和术后的全身抗肿瘤治疗，目标可能包括提高手术切除机会、控制微小病灶和降低复发风险。
| 治疗类型 | 治疗时机 | 常见试验终点 |
|---|---|---|
| 新辅助治疗 | 术前 | pCR、MPR、手术切除率 |
| 辅助治疗 | 术后 | DFS、RFS、OS |
| 围手术期治疗 | 覆盖手术前后 | EFS、OS、pCR、MPR |
KEYNOTE-671 示例。 在可切除非小细胞肺癌研究中，试验组术前接受帕博利珠单抗联合以顺铂为基础的化疗，之后接受手术切除，术后继续帕博利珠单抗治疗。
如何解读结果。 试验比较的是整套围手术期策略与对照方案。EFS 或 OS 的改善反映整体策略的效果。要量化术后免疫治疗的增量获益，需要能够单独评估术后治疗阶段的研究设计。
终点术语。 pCR 为病理完全缓解。MPR 为主要病理缓解，通常指残余活肿瘤细胞不超过 10%，具体以研究标准为准。EFS 为无事件生存期，事件定义以方案为准。DFS 为无病生存期。RFS 为无复发生存期。OS 为总生存期。
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