新辅助免疫治疗有效利用原位肿瘤作为肿瘤抗原的储存库，促进全身抗肿瘤免疫。研究表明，肿瘤内对免疫检查点抑制剂 (ICIs) 的反应是由驻留在肿瘤中的记忆 T 细胞介导的，这些细胞对多种肿瘤抗原具有特异性 ICI 治疗在肿瘤和肿瘤内产生 CD8 T 细胞的从头启动-引流淋巴结，并可以通过阻断抑制性检查点蛋白来增强抗肿瘤免疫反应，而抑制性检查点蛋白可以关闭肿瘤内的 T 细胞。新辅助 ICI 治疗可以增强瘤内和全身抗肿瘤免疫，包括与病理治疗反应密切相关的瘤内 T 细胞克隆的扩增。最近的数据显示，与单独的 ICI 辅助治疗相比，不可切除或晚期黑色素瘤患者对新辅助免疫治疗的病理反应率较高，且生存期延长。这些数据表明，通过手术切除去除肿瘤和引流淋巴结中的肿瘤特异性 T 细胞库可能会消除患者很大一部分抗肿瘤免疫力，并有可能损害 ICI 结果。© 作者（或其雇主） (s)) 2024。根据 CC BY-NC 允许重复使用。禁止商业再利用。请参阅权利和权限。英国医学杂志出版。

Neoadjuvant immunotherapy effectively uses the in situ tumor as a reservoir of tumor antigens to promote systemic antitumor immunity. Studies indicate that intratumoral responses to immune checkpoint inhibitors (ICIs) are mediated by resident memory T cells cells that are sequestered in tumors and have specificity for a wide range of tumor antigens ICI treatment produces de novo priming of CD8+ T cells in tumor and in tumor-draining lymph nodes, and can boost the antitumor immune response by blocking inhibitory checkpoint proteins that can turn off T cells within the tumor. Neoadjuvant ICI treatment can enhance both intratumoral and systemic antitumor immunity, including expansion of intratumoral T-cell clones which is strongly associated with pathological treatment response. Recent data have shown high rates of pathological response to neoadjuvant immunotherapy with prolongation of survival compared with adjuvant ICI therapy alone in patients with unresectable or advanced melanoma. These data suggest that removal of the reservoir of tumor-specific T cells in the tumor and draining nodes by surgical resection may remove a significant proportion of the patient's antitumor immunity with the potential to compromise ICI outcomes.© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.