Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan.
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Cancer Immunol Immunother. 2021 Jun;70(6):1745-1753. doi: 10.1007/s00262-020-02783-6. Epub 2021 Jan 3.
Immune checkpoint inhibitors (ICIs) have become a standard therapy in non-small cell lung cancer (NSCLC). Although lung cancer adjoining emphysematous bullae (Ca-ADJ) were reported to express higher programmed cell death-ligand 1 (PD-L1), the predictive impact of Ca-ADJ on the response to ICIs is unknown.
Two hundred and fifty-seven advanced or recurrent NSCLC patients treated with ICI monotherapy at Kyushu University Hospital and National Hospital Organization Kyushu Cancer Center were analyzed. To minimize the bias arising from the patients' background, adjusted Kaplan-Meier survival curves and Cox proportional hazards regression analyses using inverse probability of treatment weights (IPTW) were performed.
Of the 257 patients, 55 had Ca-ADJ. Patients with Ca-ADJ were significantly associated with younger age (P = 0.0343), male sex (P = 0.0070), and smoking (P = 0.0080). The objective response rate of cases with Ca-ADJ was significantly higher than that of those without Ca-ADJ (36.4% vs. 20.8%, respectively; P = 0.0167). The disease control rate of cases with Ca-ADJ was also significantly higher than tumors without Ca-ADJ (63.6% vs. 47.5%, respectively; P = 0.0341). The IPTW-adjusted Kaplan-Meier curves showed that patients with Ca-ADJ had significantly longer progression-free survival (PFS) and overall survival (OS) than those without Ca-ADJ (P = 0.0407 and P = 0.0126, respectively). On IPTW-adjusted Cox analysis, Ca-ADJ was an independent predictor of PFS and OS (P < 0.0001 and P < 0.0001, respectively).
Patients with Ca-ADJ may be good candidates for ICIs. These findings should be validated prospectively.
免疫检查点抑制剂（ICIs）已成为非小细胞肺癌（NSCLC）的标准治疗方法。尽管有报道称肺癌毗邻气肿大疱（Ca-ADJ）表达更高的程序性死亡配体 1（PD-L1），但 Ca-ADJ 对 ICI 反应的预测影响尚不清楚。
分析了在九州大学医院和国立癌症中心九州癌症中心接受 ICI 单药治疗的 257 例晚期或复发性 NSCLC 患者。为了最大程度地减少患者背景带来的偏差，使用治疗逆概率加权（IPTW）进行了调整后的 Kaplan-Meier 生存曲线和 Cox 比例风险回归分析。
在 257 例患者中，有 55 例患有 Ca-ADJ。患有 Ca-ADJ 的患者与年龄较小（P = 0.0343）、男性（P = 0.0070）和吸烟（P = 0.0080）显著相关。患有 Ca-ADJ 的病例的客观缓解率明显高于无 Ca-ADJ 的病例（分别为 36.4%和 20.8%；P = 0.0167）。患有 Ca-ADJ 的病例的疾病控制率也明显高于无 Ca-ADJ 的病例（分别为 63.6%和 47.5%；P = 0.0341）。经过 IPTW 调整的 Kaplan-Meier 曲线显示，患有 Ca-ADJ 的患者的无进展生存期（PFS）和总生存期（OS）明显长于无 Ca-ADJ 的患者（P = 0.0407 和 P = 0.0126，分别）。在经过 IPTW 调整的 Cox 分析中，Ca-ADJ 是 PFS 和 OS 的独立预测因素（P < 0.0001 和 P < 0.0001，分别）。
患有 Ca-ADJ 的患者可能是 ICI 的良好候选者。这些发现需要前瞻性验证。
