本研究围绕ALTER-L043 Ⅱ期随机临床试验展开，旨在探讨围手术期派安普利单抗（penpulimab）联合安罗替尼在联合或不联合化疗模式下治疗可切除非小细胞肺癌（NSCLC）的疗效与安全性。研究背景基于当前免疫检查点抑制剂联合化疗虽改善患者预后，但最佳联合策略及"去化疗"方案可行性仍有待探索。研究方法包括对ALTER-L043试验设计、人群特征、病理缓解率及安全性数据的全面分析，并与近年重要Ⅲ期试验对比。研究结果显示，派安普利单抗联合安罗替尼及化疗的三联方案主要病理缓解率高达76.0%（19/25），优于免疫化疗组[57.7%（15/26）]及去化疗双联组[52.4%（11/21）]，且在鳞癌[79.0%（15/19）比55.0%（11/20）比50.0%（9/18）]和ⅢA/ⅢB期[82.4%（14/17）比55.6%（5/9）比50.0%（6/12）]患者中趋势更优；去化疗方案也展现潜力。安全性整体可控。因此，该联合策略为可切除NSCLC提供了新选择，三联方案或适用于高肿瘤负荷患者，去化疗方案为不耐受者提供替代，长期获益需Ⅲ期研究验证。

This study provides an in-depth interpretation of the ALTER-L043 phase II randomized trial, focusing on the efficacy and safety of perioperative penpulimab plus anlotinib with or without chemotherapy in resectable non-small cell lung cancer (NSCLC). The investigation was motivated by the need to optimize combination strategies beyond current immunotherapy-chemotherapy regimens, including the potential of "chemotherapy-free" approaches. The analysis encompassed the design, patient characteristics, pathological response rates, and safety profile of the trial, with comparisons to recent phase III studies. Results demonstrated that the triplet regimen achieved a major pathological response rate of 76.0% (19/25), surpassing the doublet regimens [57.7% (15/26) vs. 52.4% (11/21)], with notable benefits in squamous cell carcinoma [79.0% (15/19) vs. 55.0% (11/20) vs. 50.0% (9/18)] and stage ⅢA/ⅢB disease [82.4% (14/17) vs. 55.6% (5/9) vs. 50.0% (6/12)]. The chemotherapy-free doublet also showed promising efficacy. Safety profiles were manageable across groups. In conclusion, penpulimab plus anlotinib-based therapy offers a viable perioperative option, with the triplet regimen potentially suited for high-burden disease and the doublet providing an alternative for chemotherapy-ineligible patients, though phase Ⅲ confirmation is warranted.