点上方蓝字“ioncology”关注我们，然后点右上角“…”菜单，选择“设为星标”ELCC 2025 微专辑扫描二维码可查看更多内容在2025年欧洲肺癌大会（ELCC）上，国际肺癌研究协会（IASLC）候任主席、上海市东方医院肿瘤科周彩存教授与2025 ELCC联合主席、意大利都灵大学胸外科Enrico Ruffini教授展开深度对话，讨论了新辅助化疗联合免疫治疗与微创手术的整合、围手术期免疫治疗患者选择、辅助治疗时长优化、降阶梯策略等议题，揭示了多学科协作下的治疗新范式。周彩存 教授主任医师、教授、博士生导师★ 上海市东方医院肿瘤科主任★ 同济大学医学院肿瘤研究所所长★ 国际肺癌研究协会（IASLC）候任主席★ 中国医促会胸部肿瘤学分会 主任委员★ 中国临床肿瘤学会非小细胞肺癌专委会 主任委员★ 中国抗癌协会非小细胞肺癌专委会 主任委员★ 中国抗癌协会肿瘤药物临床研究专业委员会 主任委员★ 上海市抗癌协会肺癌分子靶向和免疫治疗专委会 主任委员★ 中国医师协会肿瘤分会 常委★ 上海市抗癌协会 副理事长★ 上海市医师协会肿瘤分会 副会长★ 上海市医学会肿瘤分会 副主任委员Enrico Ruffini 教授意大利都灵大学胸外科全职教授2019-2021：欧洲胸外科医师学会（ESTS）主席2012-2014：国际胸腺肿瘤兴趣组（ITMIG）秘书长2012-2016：国际肺癌研究协会（IASLC）胸腺肿瘤分期与预后因素委员会成员2017-2024：IASLC胸腺肿瘤分期与预后因素委员会主席担任《欧洲心胸外科杂志》《胸部肿瘤学杂志》《肺癌》《胸部疾病杂志》等期刊审稿人，参编多部胸外科教材，发表SCI论文268篇，H指数51肿瘤瞭望：手术对于早期非小细胞肺癌（NSCLC）仍然至关重要。对于接受新辅助化疗联合免疫治疗的患者，手术是否会变得更复杂？Ruffini教授：这一问题在近年学术会议中经常被讨论，2025 ELCC专门设置了两场报告进行探讨。回顾历史经验，几十年前我为接受过化疗的患者进行手术，结果发现与直接手术相比，这类手术更加困难，主要归因于组织粘连、血管与肺实质及肿瘤存在解剖层次不清等问题。在新辅助化疗联合免疫治疗时代，手术复杂性进一步增加，可能是由于免疫治疗引发的炎症反应和纤维化（本质上属于治疗应答的病理表现）。但值得庆幸的是，外科技术也在不断进步，我们拥有更多手术技术和设备来处理术中并发症。2025 ELCC展示的研究中，绝大多数接受新辅助化疗联合免疫的患者可通过微创手术完成治疗，接受胸腔镜手术或机器人微创手术的患者术后恢复更容易，且微创手术后患者对辅助治疗的耐受性也优于开胸手术。综上，我们能让这些患者安全地实施微创手术。（上下滑动可查看）Dr. Ruffini: Thank you for the question. I think this is one of the questions we usually discuss at many conferences, and also this conference. Particularly at this conference, there will be two important presentations. One has just been done, and the other one is about to be discussed. About the complexity? Yes, surgical complexity after chemo-IO. When I was young, I started operating on patients after normal chemotherapy. We found it more difficult with respect to upfront surgery, because of adhesions, the loss of the planes between the vessels, the parenchyma and the tumor. We have found that after chemoimmunotherapy, surgery is even more difficult, probably because of inflammation and fibrosis induced by immunotherapy. This is the effect that we want of course for these patients. But on the other hand, we have developed improvements in the surgical technique. We have more technology. We have more devices, all to take care of intraoperative complications. In the series that was presented this morning, the vast majority of patients after chemoimmunotherapy could be operated by minimally invasive therapy, which is good, because patients after thoracoscopy or minimally invasive techniques are more ready to come back to normal life. The post-operative period is easier. These patients can much better tolerate adjuvant treatment compared to open access. So, we are working on this, we have the tools, and I am very confident that we can operate on these patients safely and with minimally invasive techniques.肿瘤瞭望：新辅助化疗联合免疫治疗、辅助免疫治疗和围手术期免疫治疗在可切除NSCLC患者中均积累了循证证据。哪些NSCLC患者更能从围手术期免疫治疗中获益？周教授：目前已有足够数据支持围手术期免疫治疗（新辅助化疗联合免疫治疗+辅助免疫治疗）在早期可切除NSCLC患者中的应用。综合多项试验数据，III期或II期患者可能从围手术免疫治疗中获益更多，病理完全缓解（pCR）率约为25%，这一数值在新辅助化疗中并不常见。我认为III期或II期NSCLC患者更应接受围手术期治疗，该疗法的安全性尚可接受，大部分患者的不良事件为1级或2级，且可通过常规手段管理。（上下滑动可查看）Dr. Zhou: Nowadays, we have enough data to support neoadjuvant chemo-IO and adjuvant IO in early stage resectable non-small cell lung cancer. When we look at all the data across trials, maybe stage 3 or stage 2 can get much more benefit from this therapy. The pCR rate is around 25%, which is not bad and seldom seen with neoadjuvant chemotherapy. I do think stage 3 or stage 2 get more benefit from perioperative neoadjuvant chemo-IO therapy. The safety profile of this therapy is acceptable. The majority of patients experience grade 1 or grade 2 adverse events. The majority of events are manageable with common practices. I support neoadjuvant plus adjuvant chemo-IO in the early stage NSCLC.肿瘤瞭望：2025 ELCC争议专场讨论了辅助治疗时间。请您谈一谈早期NSCLC术后辅助免疫治疗的最佳时长。周教授：这是一个尚未解答的重要问题。根据临床试验，辅助化疗通常持续约一年，但免疫治疗的时长尚无明确标准，尤其是对达到pCR的患者而言。一年的辅助免疫治疗可能过长，部分研究已探索对pCR患者进行6个月的辅助免疫治疗。无论如何，我们需要更多数据和临床试验来确定免疫治疗的理想时长。Ruffini教授：我完全同意。因为免疫治疗的疗效毋容置疑，下一步应筛选出真正能从辅助免疫治疗中获益的患者,使患者得到最大程度获益。例如，若患者术后达到pCR，理论上已治愈，没有可检测到的肿瘤，是否还需要辅助治疗？为此，我们需要寻找和评估生物标志物（如循环肿瘤DNA），以判断是否有肿瘤细胞存在于血液中的间接证据，若有证据，全身疗法用于辅助治疗是有效的。我认为下一步研究重点是对接受新辅助化疗免疫治疗和手术的患者进行筛选，以判断其应当还是不应当进行辅助治疗。周教授：我们需要生物标志物筛选适合围手术期化疗免疫治疗的患者，但目前尚无确凿的生物标志物。现有证据显示PD-L1表达可能与疗效相关，近期研究应重视循环肿瘤DNA和循环肿瘤细胞（CTC），但其检测方法仍需标准化验证。我们需要开展研究对生物标志物的预测效果进行验证，联合胸外科、肿瘤内科和转化医学等领域的科学家，共同寻找最佳生物标志物。（上下滑动可查看）Dr. Zhou: That is an important question we haven’t answered so far. According to clinical trials, the duration of adjuvant chemo is about one year. But we are not sure of the proper standard duration of immunotherapy, especially for those pCR patients. One year of immunotherapy may be too long. Some studies have investigated six months of adjuvant immunotherapy for pCR patients. Anyway, we need data. We need clinical trials to determine optimal duration of IO in these populations. What is your idea?Dr. Ruffini: I completely agree. I think the next step would be to select the patients who would benefit or not from adjuvant therapy. For the focus of our research in the coming years, we all know that immunotherapy is effective – there is no doubt about that – but we have to select the best patients in order to get the greatest benefit. For example, if after surgery, you have a pathologic complete response, should these patients receive adjuvant chemotherapy or not? In theory, they are cured. There is no detectable disease. Of course, we need some biomarkers, like circulating DNA, for example, to see if there is indirect evidence of tumor cells in the blood, and in that case, systemic therapy in an adjuvant setting might be effective. But I think the focus of the next research will be just to select the population to whom to offer or not to offer adjuvant chemotherapy after chemo-IO and surgery. This is my thought.Dr. Zhou: I totally agree. We need a biomarker to select the right patients for perioperative chemo-IO. As for a biomarker, so far, we don’t have solid biomarkers. We know that PD-1 expression may be associated with better efficacy for perioperative chemo-IO. In the near future, we should look at circulating DNA and circulating tumor cells, but so far, we have not established a testing platform for what the standard method of testing for ctDNA and circulating tumor cells should be. We need studies to confirm the predictive effect of these biomarkers. We need a study. We need surgeons, medical oncologists and translational scientists to work together to find the best biomarkers for our daily practice.肿瘤瞭望：Benjamin Besse教授在2025 ELCC作重要报告《少即是多：患者管理和临床试验中的降级策略》。请两位专家谈一谈如何在降低毒性和成本的同时维持疗效，实现肺癌治疗的“降阶梯”？ Ruffini教授：关于降阶梯，核心仍在于以生物标志物筛选患者。若明确某种疗法对患者无效，则可考虑降阶梯治疗。但据我所知，目前这个问题尚无定论，需要通过研究数据来建立假设、形成证据。周教授：目前我们缺少足够的研究数据来解答这一关键问题，但可以明确的是，新型化合物的开发是提高疗效的关键。中国研究者正在探索双特异性抗体联合化疗的围手术期治疗方案，研究数据显示其安全性良好，但疗效仍需进一步验证。此外，TROP2抗体偶联药物（ADC）德曲妥珠单抗联合免疫治疗的II期研究正在进行，同时，多个新型化合物也在新辅助治疗领域展开研究。双特异性抗体、双特异性ADC等新型药物层出不穷，各种联合方案正在探索中。任何治疗方案都需要平衡疗效和安全性，还要考虑经济毒性，因为许多患者无法承担费用高昂的治疗方案。合理的治疗方案应权衡疗效、毒性和经济毒性。Ruffini教授：不同国家的医疗政策差异也需考虑。例如在意大利，药物费用由国家卫生系统报销，患者无需为治疗药物付费，但其他很多国家并非如此。周教授提出的“经济毒性”概念很有价值——毒性意味着成本，不仅是药物本身的费用，还包括治疗并发症产生的费用，这个概念值得在全球范围深入探讨。周教授：完全同意。在评估新疗法的疗效时，不应仅关注pCR率，更需要重视长期生存获益（包括中期生存和长期生存数据）。关键问题在于，有多少患者能通过该疗法实现临床治愈。目前围手术化疗联合免疫治疗的pCR率约20-25%，能否进一步提升至40-50%？疗效评估不应局限于部分缓解（PR）等短期指标，而应以治愈率为核心。Ruffini教授：患者追求的是治愈和长期生存，而非单纯的病理完全缓解。当然二者可能存在关联，但这种关联尚不明确。（上下滑动可查看）Dr. Ruffini: I can reply for the first part, and probably Professor Zhou is the expert for the second part. For the first part, again we come back to the previous discussion. Once again, the selection of these patients depends on biomarkers. If we know that this treatment is not effective then OK, we can de-escalate. But so far, to my knowledge, we do not know. So, we need studies and we need data in order to make assumptions to make evidence. If there are any ongoing trials, I think Professor Zhou can explain.Dr. Zhou: That is a great question. So far, we do not have much data to answer the question, but we do know that we need novel compounds or agents to improve efficacy. In China, we have bispecifics to combine with chemo in the perioperative setting. So far, the safety is quite good, but we need better efficacy. We also have a study investigating ADC-based immunotherapy with the TROP2 datopotamab deruxtecan ADC combined with IO in a phase II study. We are waiting for the result of this study. There are several novel compounds also being studied in the neoadjuvant setting. So far, I will say that this combination of therapy is acceptable, but we need the efficacy data, especially a phase III trial to confirm the efficacy and safety profile. Anyway, there are so many novel compounds. We have bispecifics. We have bispecific ADCs. Maybe the combination of these compounds can further improve efficacy. For any therapy, we should balance efficacy and safety – the treatment should be quite effective, but not too toxic. We also need to consider the economic toxicity. That is very important. Nowadays, expensive therapies are not accessible to many patients. We need to consider the balance between the efficacy, safety profile and economic toxicity. That is my thoughts.Dr. Ruffini: And probably, different countries have different policies. For example, in Italy, all of these drugs are reimbursed by the National Health System. The state, of course, has a considerable economic burden. The patients don’t pay for the drug. This is what happens in Italy of course, but every country has different healthcare policies. This is something that has to be taken into account. I really liked the concept that Professor Zhou raises – that of economic toxicity. If there is a toxicity, of course there is a cost. It is a cost for the state to take care of the complications from the toxicity, not only the cost of the compound, but also the cost of treating and curing the adverse effects. I really like this this concept. Of course, we need to have a global discussion on that. This is something that has to be taken into account.Dr. Zhou: I totally agree. When we look at efficacy, we should counter the pCR rate. We also need to consider long-term survival, not only medium-term survival. We should consider how many patients can be cured with a novel therapy. Nowadays, the pCR rate with chemo-IO is about 20-25%. Can we increase the rate to 40-50%? We need to look at efficacy data for, not just partial response, nPR, etc., but cure rates are also important.Dr. Ruffini: What patients want is to be cured and to live long lives, not to have a complete pathologic response. Of course, maybe they are correlated, but we don’t know.肿瘤瞭望：2025 ELCC讨论了“生活质量明确恶化时间（TTDD）是否应成为早期NSCLC免疫治疗的新关键终点”，请两位专家针对这一话题分享思考。周教授：在临床实践中，若新疗法无法改善患者的生活质量，则不应被常规采纳。我们应给予患者报告结局（PRO）更多关注，因为生活质量对患者来说很重要。Ruffini教授：我完全赞同。在浏览2025 ELCC壁报时，我发现一些研究探索了生活质量指标这个关键议题。我们现已建立完善的评估体系来衡量生活质量，这正是"以患者为中心"医疗理念的核心要义——让患者成为治疗的中心焦点。若真正践行这一理念，就意味着必须将生活质量纳入关键考量维度。如果一种方案“治愈”患者却同时摧毁其生活质量，那么这种治疗毫无价值，我们必须在疗效与生存质量之间取得平衡。（上下滑动可查看）Dr. Zhou: That’s a great question. How we treat our patients should improve quality of life. If a new therapy does not improve quality of life, it is not acceptable in our daily practice. Quality of life is very important. We should pay more attention to patient-reported outcomes.Dr. Ruffini: Yes, I cannot agree more. I had a look at the posters, for example, and some posters addressed this very important issue – quality of life. We have metrics to measure quality of life. This is part of what we call patient-centered medicine – to put the patient at the center of our cure. If we want to put the patient at the center of our treatment process, this means also taking into account the quality of life. In my opinion, it is completely worthless to cure a patient, but at the same time, destroy the patient – to reduce the patient to a very poor quality of life, psychologically or functionally. We need to provide a balance in that regard. For this reason, I think your question is very pertinent.肿瘤瞭望：周教授，您在2025 ELCC发布了CameL-sq研究5年生存数据更新。请谈一谈的CameL-sq研究设计及其5年生存数据对晚期肺鳞癌治疗的意义。周教授：CameL-sq是一项对比卡瑞利珠单抗联合化疗与单纯化疗治疗局部晚期或转移性鳞状NSCLC的III期临床试验。结果显示，CameL-sq方案的5年总生存（OS）率达27.8%，5年无进展生存（PFS）率为18.2%。这表明超1/4患者实现“临床治愈”（生存突破5年），18.2%的患者疾病控制超过5年，这是非常不错的结果。CameL-sq方案的价值不仅体现在中位OS延长数月（27.4个月 vs. 15.5个月），其真正的临床意义在于显著提高了患者的长期生存获益。在晚期肺癌研究中，现今应更关注长期生存结局——特别是3年、5年等关键时间节点的OS率数据。我认为未来的临床试验应将长期生存率（如5年生存率）设为主要终点或关键次要终点。临床应使用那些能带来良好长期生存获益的治疗方案。Ruffini教授：晚期肺癌患者实现五年生存，这在几年前被视为天方夜谭。周教授及其团队值得高度赞誉，这是非凡的成就，这是可以在临床实施的方案。（上下滑动可查看）Dr. Zhou: Thank you very much for giving me the opportunity to present our data. In this study, we got a very good 5-year survival rate of 27.8%, and a 5-year PFS rate of 18.2%. Excellent results. These data suggest that about one-quarter of patients could get clinical control for five years, and about 18% of patients can be disease-controlled for more than five years. Not bad data. So therapy does not just improve median overall survival by a couple of months (a couple of months for a lung cancer patient is nothing). Nowadays, we should be counting how many patients survive longer – 3-year survival, 4-year survival and 5-year survival rate. I do think that long-term survival, such as the 5-year survival rate, should be the primary endpoint or key secondary endpoint in future clinical studies. We need to consider therapies with good long-term survival. That’s my thought.Dr. Ruffini: just a brief comment. Of course, the study was in advanced disease if I understood correctly, but just thinking of 5-year survival in advanced disease, is something absolutely unbelievable. Just a few years ago, it would have been absolutely absurd to talk about 5-year survival in advanced disease. Professor Zhou and his team should be congratulated. This is a fantastic achievement. This is of course something that needs to be implemented.肿瘤瞭望：Ruffini教授，您希望参会者从ELCC 2025中获取哪些胸外科领域的关键信息？Ruffini教授：在肺癌等胸部恶性肿瘤研究成果令人振奋的背景下，2025 ELCC聚焦三大胸部肿瘤：肺癌、胸腺肿瘤和胸膜间皮瘤。对于每一种肿瘤，胸外科手术都能发挥重要作用。在肺癌领域，通过综合治疗手段的应用（如新辅助化疗联合免疫、辅助治疗及围手术治疗），手术在分期更晚的肺癌中的角色出现改变，我们正在探索挽救性手术，也就是完成根治性放化疗和免疫治疗后的手术治疗。外科手术始终在肺癌治疗中占据重要地位，如今我们拥有更多的手术技术和设备，能够为患者提供安全性极高的手术，并缩短术后恢复时间，然后接受后续辅助免疫治疗和/或辅助化疗。我很高兴在2025 ELCC看到众多中国学者的研究成果展示，也结识了许多中国同行。你们确实处于胸外科发展的最前沿，所做的卓越工作有目共睹。我在欧美多个学术会议上都能看到中国胸外科同行的杰出成果。我们就像一个团结的大家庭，构建这样的学术共同体至关重要。目前有各种便捷沟通工具可实现跨国交流，每次通过Zoom会议（尽管要克服时差）与中国同行交流都让我倍感愉悦，与美国同行的合作也是如此。在胸膜间皮瘤领域，我们正在通过新的MARS2临床试验重新探讨手术的价值。根据2025 ELCC“间皮瘤治疗更新”教育专场的讨论，手术仍可在胸膜间皮瘤治疗中发挥作用。对于胸腺肿瘤，手术在所有分期胸腺瘤治疗中占据不可争议的地位，但成功的核心仍在于多学科协作——需要肿瘤内科、放疗科、病理科和呼吸科专家共同参与决策。如果各大洲、各国之间缺乏这样的学术交流，我们就无法取得任何实质性的进展。周教授：完全同意。外科始终是胸部肿瘤治疗的核心和基石，无论是肺癌、胸腺瘤抑或胸膜间皮瘤。我们肿瘤内科医生需要与外科团队及多学科同仁紧密协作，通过多学科诊疗模式提升患者的临床治愈率，有效改写癌症的自然转归。（上下滑动可查看）Dr. Ruffini: Thank you for the question. I think that we are living in a really exciting period in the research about lung cancer, and for thoracic malignancies as well. So, I would like to extend the concept. This Conference was designed for three thoracic cancers – lung cancer, thymic tumors and pleural mesothelioma. For each of these, I think thoracic surgery can play a great role. Now, with the use of integrated treatment, like chemo-IO, plus adjuvant and perioperative strategies, this has really changed the scenario of the role of surgery in the more advanced disease. We are now talking about salvage surgery, meaning surgery after definitive chemo-, radio- and immunotherapy. Surgery continues to have a role in the treatment of lung cancer. As I said at the beginning of this interview, we now have much more technology, more tools and more devices to provide these patients with a very safe surgery with a short post-operative period in order for them to recover quickly, in order to get access to adjuvant immunotherapy and/or adjuvant chemotherapy. This is a major step forward for thoracic surgery. I was very glad to see a lot of Chinese posters here, I know many Chinese colleagues. You are really in the frontline of thoracic surgery advances. You are doing a fantastic job. I can see the results of my thoracic surgery colleagues at many conferences across the United States and Europe. So, we are a big family, all together. It is important to have this big community. We have all the tools to communicate. We have Zoom calls. Sometimes you are very early in the morning and sometimes you are in the middle of the night. Sometimes we are in the middle of the night. But it is fun. Every time I communicate with my Chinese colleagues, I am very happy. It is the same for my US colleagues and so on. This is for lung cancer. For pleural mesothelioma, we are now discussing the role of surgery, which was entered into the discussion with the new MARS2 trial. This morning, we discussed that surgery can still have a role in pleural mesothelioma. Finally, for thymic tumors, surgery has an indisputable role across all stages of disease, but once again, the key to this success is the multidisciplinary approach, for the medical oncologist, the radiation oncologist, pathologist, pulmonologist to talk together. This is the key. If there is no communication between us, between continents and between countries, then we are not progressing anywhere.Dr. Zhou: I totally agree. More and more, surgery is at the center of the treatment of thoracic cancer – lung cancer, thymic tumors and mesothelioma. We need surgery. We are a team. As a team, we should work together. We should communicate together. In that way, we can improve the cure rate for our patients. We can change the natural history of cancer. We should work together. Thank you very much.《肿瘤瞭望》在ELCC现场报道（来源：《肿瘤瞭望》编辑部）声 明凡署名原创的文章版权属《肿瘤瞭望》所有，欢迎分享、转载。本文仅供医疗卫生专业人士了解最新医药资讯参考使用，不代表本平台观点。该等信息不能以任何方式取代专业的医疗指导，也不应被视为诊疗建议，如果该信息被用于资讯以外的目的，本站及作者不承担相关责任。
