Lim Jeong Uk, Kim Soo Han, Kang Hye Seon, Kim Sung Kyoung, Kim Ju Sang, Kim Jin Woo, Kim Seung Joon, Yeo Chang Dong, Choi Chang Min
Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 07345, Korea.
Asan Medical Center, Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Seoul 05505, Korea.
J Clin Med. 2021 Aug 21;10(16):3719. doi: 10.3390/jcm10163719.
The present study evaluated the impact of prior radiotherapy (RT) on patients with advanced non-small cell lung cancer (NSCLC) receiving therapy with immune checkpoint inhibitors (ICIs) and further assessed the prognostic factors in patients receiving both RT and ICI. Patients diagnosed with NSCLC at the Catholic Medical Center and Asan Medical Center between January 2016 and October 2020 and who received immunotherapy were retrospectively reviewed. Among 240 patients, poor Eastern Cooperative Oncology Group (ECOG) score, high PD-L1 expression, and ICI-related adverse events (AE) were significantly associated with progression-free survival (PFS) (HR, 2.654; 95% CI, 1.484-4.749; = 0.001; HR, 0.645; 95% CI, 0.449-0.926, = 0.017; HR, 0.430; 95% CI, 0.229-0.808; = 0.009, respectively). Among patients who received both RT and immunotherapy, poor ECOG status, squamous cell carcinoma, and ICI-related AE were significant factors associated with poor PFS (HR, 2.430; 95% CI, 1.464-4.034; = 0.001; HR, 0.667; 95% CI, 0.455-0.978, = 0.038; HR, 0.520; 95% CI, 0.284-0.953, = 0.034, respectively). The present study showed that prior RT showed no significant independent association with primary outcomes in patients with advanced NSCLC receiving immunotherapy. In patients who received both RT and immunotherapy, clinical parameters, including ICI-related AEs, were independently predictive of PFS.
本研究评估了既往放疗（RT）对接受免疫检查点抑制剂（ICI）治疗的晚期非小细胞肺癌（NSCLC）患者的影响，并进一步评估了接受RT和ICI联合治疗患者的预后因素。对2016年1月至2020年10月期间在天主教医疗中心和峨山医疗中心被诊断为NSCLC并接受免疫治疗的患者进行了回顾性分析。在240例患者中，东部肿瘤协作组（ECOG）评分差、程序性死亡配体1（PD-L1）高表达以及ICI相关不良事件（AE）与无进展生存期（PFS）显著相关（风险比[HR]，2.654；95%置信区间[CI]，1.484 - 4.749；P = 0.001；HR，0.645；95% CI，0.449 - 0.926，P = 0.017；HR，0.430；95% CI，0.229 - 0.808；P = 0.009，分别）。在接受RT和免疫治疗的患者中，ECOG状态差、鳞状细胞癌以及ICI相关AE是与PFS差相关的显著因素（HR，2.430；95% CI，1.464 - 4.034；P = 0.001；HR，0.667；95% CI，0.455 - 0.978，P = 0.038；HR，0.520；95% CI，0.284 - 0.953，P = 0.034，分别）。本研究表明，既往RT与接受免疫治疗的晚期NSCLC患者的主要结局无显著独立相关性。在接受RT和免疫治疗的患者中，包括ICI相关AE在内的临床参数可独立预测PFS。
