Sakai Kosuke, Kuramoto Joji, Nishimura Hiroaki, Kuwabara Yoshiki, Kojima Akitoshi, Sasaki-Toda Maiko, Ogawa-Kobayashi Yumiko, Kikuchi Satoshi, Hirata Yusuke, Mikami-Saito Yuriko, Mikami Shintaro, Kyoyama Hiroyuki, Moriyama Gaku, Gemma Akihiko, Uematsu Kazutsugu
Department of Pulmonary Medicine, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama 350-8550, Japan.
Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan.
J Thorac Dis. 2021 Aug;13(8):4903-4914. doi: 10.21037/jtd-21-774.
Immune-checkpoint inhibitors (ICIs) have been increasingly used for non-small cell lung cancer (NSCLC) treatment in recent years. Although insufficient, the rate of programmed death-ligand 1 expression has been adopted as a predictor of ICI efficacy. We evaluated tumor growth rate as a clinically easy-to-use predictor of the therapeutic effect of ICIs.
This study is a single-institution retrospective study in Japan. NSCLC patients treated with nivolumab, pembrolizumab, or atezolizumab at Saitama Medical Center from January 1, 2016 to December 31, 2018 were enrolled, and followed until December 31, 2020. We defined and calculated the initial rapidity of tumor progression (IRP) as: the increase in the sum of the diameters of intrathoracic tumors and lymph nodes on two series of chest computed tomography (CT) scans (one obtained at an initial checkup and the other obtained immediately before the first treatment) divided by the number of days between these CT scans. Two coefficients were calculated: the maximal information coefficient (MIC) between IRP and time to treatment failure (TTF) using the Python package with minepy library, and the Spearman's rank correlation coefficient.
A total of 55 patients (median age, 70 years; 47 men) were enrolled. The median TTF with ICIs was 126 days, and four patients continued to receive ICI treatment at the end of the follow-up. The MIC between IRP and TTF was 0.302 with weak correlation, and the Spearman's rank correlation coefficient was -0.347 (P=0.00938).
The initial tumor growth rate had a negative linear correlation with the therapeutic effect of ICIs.
近年来，免疫检查点抑制剂（ICI）越来越多地用于非小细胞肺癌（NSCLC）的治疗。尽管程序性死亡配体1表达率作为ICI疗效的预测指标尚不充分，但已被采用。我们评估了肿瘤生长速率作为一种临床易用的ICI治疗效果预测指标。
本研究是在日本一家机构进行的回顾性研究。纳入了2016年1月1日至2018年12月31日在埼玉医疗中心接受纳武单抗、派姆单抗或阿特珠单抗治疗的NSCLC患者，并随访至2020年12月31日。我们将肿瘤进展的初始速度（IRP）定义并计算为：两次胸部计算机断层扫描（CT）（一次在初次检查时获得，另一次在首次治疗前立即获得）上胸腔内肿瘤和淋巴结直径总和的增加量除以这两次CT扫描之间的天数。计算了两个系数：使用带有minepy库的Python包计算IRP与治疗失败时间（TTF）之间的最大信息系数（MIC），以及斯皮尔曼等级相关系数。
共纳入55例患者（中位年龄70岁；47例男性）。ICI治疗的中位TTF为126天，4例患者在随访结束时继续接受ICI治疗。IRP与TTF之间的MIC为0.302，相关性较弱，斯皮尔曼等级相关系数为-0.347（P = 0.00938）。
初始肿瘤生长速率与ICI的治疗效果呈负线性相关。
