Lu Tao, Zhang Longfeng, Chen Mingqiu, Zheng Xiaobin, Jiang Kan, Zheng Xinlong, Li Chao, Xiao Weijin, Miao Qian, Yang Shanshan, Lin Gen
Department of Radiology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, People's Republic of China.
Department of Thoracic Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, People's Republic of China.
Cancer Manag Res. 2021 Jul 30;13:5931-5939. doi: 10.2147/CMAR.S319480. eCollection 2021.
Predictive markers for guidance and monitoring of immunotherapy in lung squamous cell carcinoma (LSCC) are an interesting topic but have yet to be fully explored. A primary characteristic of LSCC is tumor necrosis that results in extensive immune suppression in patients. We sought to assess whether tumor necrosis or cavity on baseline CT could effectively predict the efficacy of immune checkpoint inhibitors (ICIs) in advanced LSCC.
Advanced LSCC cases undergoing pre-treatment chest CT imaging and receiving ICIs were retrospectively collected. All CT images were reviewed by an independent chest radiologist blinded to any previous diagnosis to confirm morphological alterations in necrosis or cavity. We performed Logistic regression and developed Cox proportional hazards models to assess the predictive performance of baseline necrosis or cavity characteristics in advanced LSCC. Survival estimates were observed using Kaplan-Meier curves.
Ninety-three patients were eligible for analysis, predominantly consisting of patients with ECOG performance status of 0 or 1 (97.8%), male patients (95.7%), and heavy smokers (92.5%). Intrapulmonic necrosis or cavity on CT scan was present in 52.7% of all patients. Generally, the objective response rate (ORR) in patients with necrosis or cavity to ICI treatment was significantly worse versus those without (30.6% vs 54.5%, = 0.020), with the subgroup ORRs as follows: ICI monotherapy (necrosis vs non-necrosis: 10.0% vs 36.8%, =0.047) and ICI combination therapy (44.8% vs 68.0%, =0.088). Multivariable analysis identified intrapulmonic necrosis or cavity at baseline as a major risk factor for advanced LSCC (HR 4.042, 95% CI1.149-10.908, = 0.006). Multivariate Cox analysis showed that baseline necrosis or cavity and ICI monotherapy were unfavorable factors for progression-free survival (HR 1.729; 95% CI1.203-2.484, =0.003).
LSCC patients with intrapulmonic cavity or necrosis on baseline CT scan may respond poorly to anti-PD-(L)1-treatment, monotherapy and combination therapy alike.
用于指导和监测肺鳞状细胞癌（LSCC）免疫治疗的预测标志物是一个有趣的话题，但尚未得到充分探索。LSCC的一个主要特征是肿瘤坏死，这会导致患者出现广泛的免疫抑制。我们试图评估基线CT上的肿瘤坏死或空洞是否能有效预测晚期LSCC中免疫检查点抑制剂（ICI）的疗效。
回顾性收集接受治疗前胸部CT成像并接受ICI治疗的晚期LSCC病例。所有CT图像均由一位对既往任何诊断不知情的独立胸部放射科医生进行审查，以确认坏死或空洞的形态学改变。我们进行了逻辑回归分析，并建立了Cox比例风险模型，以评估晚期LSCC中基线坏死或空洞特征的预测性能。使用Kaplan-Meier曲线观察生存估计值。
93例患者符合分析条件，主要包括ECOG体能状态为0或1的患者（97.8%）、男性患者（95.7%）和重度吸烟者（92.5%）。所有患者中，52.7%的患者CT扫描显示肺内有坏死或空洞。一般来说，有坏死或空洞的患者接受ICI治疗的客观缓解率（ORR）明显低于无坏死或空洞的患者（30.6%对54.5%，P = 0.020），亚组ORR如下：ICI单药治疗（坏死组对非坏死组：10.0%对36.8%，P = 0.047）和ICI联合治疗（44.8%对68.0%，P = 0.088）。多变量分析确定基线时肺内坏死或空洞是晚期LSCC的主要危险因素（HR 4.042，95%CI 1.149 - 10.908，P = 0.006）。多因素Cox分析表明，基线坏死或空洞以及ICI单药治疗是无进展生存期的不利因素（HR 1.729；95%CI 1.203 - 2.484，P = 0.003）。
基线CT扫描显示肺内有空洞或坏死的LSCC患者对抗PD -（L）1治疗的反应可能较差，无论是单药治疗还是联合治疗。
