Kuroda Hiroaki, Takahashi Yusuke, Shirai Suguru, Takahara Hirotomo, Nakada Takeo, Sakakura Noriaki, Matsushita Hirokazu
Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan.
Division of Translational Oncoimmunology, Aichi Cancer Research Institute, Nagoya, Japan.
Ann Transl Med. 2021 Aug;9(15):1225. doi: 10.21037/atm-21-1492.
Selected patients in non-small cell lung cancer (NSCLC) responded to the treatment of immune checkpoint inhibitors (ICIs) have the survival benefit for advanced stages or metastatic status.
We investigated whether a response to ICI monotherapy since 2016 influences the survival of NSCLC patients with recurrence after completely pulmonary resection between 2009 and 2017. Disease control rate (DCR) was calculated as complete plus partial response plus stable disease during more than 6 months.
Thirty-five patients (mean age 67 years, range 46-79 years, 60% male) were included in the study. The most frequent histology and pathological stage were adenocarcinoma (60%) and IIB (45.7%), respectively. ICI was used at a median of second-line treatment. The DCR and median progression-free survival were 42.8% and 2.5 (95% CI: 1.6-3.4) months, respectively. The therapeutic outcome from recurrence was 47.5%. Multivariate analysis revealed a significant impact of DCR on favorable therapeutic outcome (P=0.04). A serial increase (pre- to post-surgery to ICI initiation) of C-reactive protein (CRP) and prognostic nutritional index (PNI) was associated with treatment response (both P=0.01).
These results suggest that a response to ICI monotherapy significantly contributes to a survival benefit regardless of therapeutic lines in NSCLC patients with recurrence after completely pulmonary resection, and the therapeutic response is strongly associated with a serial increase in CRP or decrease in prognostic nutritional index.
非小细胞肺癌（NSCLC）中部分对免疫检查点抑制剂（ICI）治疗有反应的患者在晚期或转移状态下具有生存获益。
我们研究了自2016年起对ICI单药治疗的反应是否会影响2009年至2017年间完全肺切除术后复发的NSCLC患者的生存情况。疾病控制率（DCR）计算为完全缓解加部分缓解加疾病稳定超过6个月。
35例患者（平均年龄67岁，范围46 - 79岁，60%为男性）纳入研究。最常见的组织学类型和病理分期分别为腺癌（60%）和IIB期（45.7%）。ICI中位用于二线治疗。DCR和中位无进展生存期分别为42.8%和2.5（95%CI：1.6 - 3.4）个月。复发后的治疗有效率为47.5%。多因素分析显示DCR对良好治疗效果有显著影响（P = 0.04）。C反应蛋白（CRP）和预后营养指数（PNI）从术前到术后再到ICI开始时的系列升高与治疗反应相关（均P = 0.01）。
这些结果表明，对于完全肺切除术后复发的NSCLC患者，无论治疗线数如何，对ICI单药治疗的反应均显著有助于生存获益，且治疗反应与CRP的系列升高或预后营养指数的降低密切相关。
