肺癌 — 围手术期 IO、KRAS NSCLC
围手术期 IO 已经是 MNC 主战场。中国 PD-L1 抗体（adebrelimab）用 EFS 数据挤进同一张桌子。下一步不是再报一个缓解率，而是停药能不能由 MRD 决定、双抗能不能在新辅助里超过单抗。
对可手术的Ⅱ至ⅢB期非小细胞肺癌（NSCLC），手术联合（新）辅助全身治疗虽是标准方案，转移性复发仍常见且与不良生存相关[1]，而Ⅲ期疾病异质性强，新辅助治疗加手术与根治性放化疗孰优孰劣曾长期难分高下[3]。新辅助纳武利尤单抗联合化疗的Ⅲ期研究把中位无事件生存（EFS）从20.8个月提高到31.6个月（HR 0.63），病理完全缓解率达24.0%[2]，后续总生存分析进一步显示死亡风险下降（HR 0.72；5年总生存率65.4%对55.0%）[4]，由此确立围手术期免疫治疗地位。但IASLC共识同时提醒，Ⅱ、Ⅲ期可切除NSCLC仍有大量知识空白待解[5]，且已发表的关键Ⅲ期证据来自抗PD-1单抗纳武利尤单抗[2][4]，疗效预测标志物尚在探索。
新消息来自2026年4月17—22日在圣迭戈举行的AACR年会[7]：一项Ⅲ期研究显示，在可切除Ⅱ、Ⅲ期NSCLC的围手术期治疗中加入抗PD-L1抗体adebrelimab联合化疗带来获益；据报道，该方案显著改善了EFS与主要病理缓解（MPR），安全性可控[8]。这一Ⅲ期并非凭空而来：adebrelimab（SHR-1316）联合白蛋白紫杉醇与卡铂的围手术期方案此前已在Ⅰb期接受评估[9]，并在可切除Ⅱ—Ⅲ期NSCLC中报告了较高的MPR率[10]。消息还强调，ctDNA清除作为预测疗效的潜在生物标志物重要性持续上升；所谓ctDNA清除率，即治疗后血浆中循环肿瘤DNA转为检测不到的患者比例[11]。
放回上述脉络，本次数据的推进有二。其一，此前确立围手术期免疫治疗格局的Ⅲ期证据均基于抗PD-1药物[2][4]，这条消息把“免疫检查点抑制剂联合化疗”的获益延伸到抗PD-L1通路的adebrelimab；其二，该药已有围手术期经验背书——在食管鳞癌新辅助Ⅰb期研究中达到安全性与可行性主要终点，pCR率8%，2年总生存率92%[6]——如今在NSCLC获得Ⅲ期支持。相较之下，靶向治疗在早期NSCLC仅有辅助奥希替尼获批、尚无获批的新辅助靶向药[1]，而ctDNA清除若获验证，有望为疗效预测提供一种动态监测工具。
当然，消息本身未披露具体疗效数字，也未提及总生存结果；“潜在标志物”的措辞本身就提示ctDNA清除的检测标准与临床决策价值尚未确立，正如IASLC专家组所言，不少关键问题仍需数年才能有确切答案[5]。
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- 5.Neoadjuvant and Adjuvant Treatments for Early Stage Resectable NSCLC: Consensus Recommendations From the International Association for the Study of Lung Cancer · J Thorac Oncol 2024
- 6.Neoadjuvant adebrelimab in locally advanced resectable esophageal squamous cell carcinoma: a phase 1b trial · Nat Med 2023
- 7.AACR Annual Meeting 2026 · aacr.org 2026
- 8.Abstract CT014: Perioperative adebrelimab (A) plus ... · researchgate.net 2026
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- 10.176TiP: Perioperative adebrelimab plus chemotherapy for ... · jto.org 2026
- 11.Perioperative Management of Non-Small Cell Lung Cancer ... · mdpi.com 2026
#AACR26 Perioperative adebrelimab (vs placebo) improved MPR (53.8% vs 18.4%) and pCR rates (31.1% vs 7.6%) with an OS trend (HR 0.57). ctDNA dynamics predictive of MPR, pCR, and EFS as well.
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