School of Medicine, South China University of Technology, Guangzhou, Guangdong 511400, China.
Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, China.
Chin Med J (Engl). 2022 Jun 20;135(12):1404-1413. doi: 10.1097/CM9.0000000000002217.
Response to immune checkpoint inhibitors (ICIs) is affected by multiple factors. This study aimed to explore whether sites of metastasis are associated with clinical outcomes of ICIs in advanced non-small-cell lung cancer (NSCLC) patients.
The data of NSCLC patients with high programmed death-ligand 1 expression and good performance status receiving first-line ICIs monotherapy from Guangdong Provincial People's Hospital between May 2019 and July 2020 were retrospectively analyzed. Metastatic sites included liver, bone, brain, adrenal gland, pleura, and contralateral lung. Progression-free survival (PFS) and overall survival (OS) were compared between different metastatic sites and metastatic burden by the Kaplan-Meier method. Organ-specific disease control rate (OSDCR) of different individual metastatic sites was evaluated.
Forty NSCLC patients meeting the criteria were identified. The presence of liver metastasis was significantly associated with shorter PFS (3.1 vs . 15.5 months, P = 0.0005) and OS (11.1 months vs . not reached, P = 0.0016). Besides, patients with bone metastasis tend to get shorter PFS (4.2 vs . 15.5 months, P = 0.0532) rather than OS ( P = 0.6086). Moreover, the application of local treatment could numerically prolong PFS in patients with brain metastasis (15.5 vs . 4.3 months, P = 0.1894). More metastatic organs involved were associated with inferior PFS ( P = 0.0052) but not OS ( P = 0.0791). The presence of liver metastasis or bone metastasis was associated with more metastatic organs (Phi[ϕ]: 0.516, P = 0.001). The highest OSDCR was observed in lung (15/17), and the lowest in the liver (1/4).
Metastases in different anatomical locations may be associated with different clinical outcomes and local tumor response to ICIs in NSCLC. ICIs monotherapy shows limited efficacy in patients with liver and bone metastasis, thus patients with this type of metastasis might require more aggressive combination strategies.
免疫检查点抑制剂（ICIs）的反应受多种因素影响。本研究旨在探讨转移性病灶是否与晚期非小细胞肺癌（NSCLC）患者接受一线 ICIs 单药治疗的临床结局相关。
回顾性分析 2019 年 5 月至 2020 年 7 月广东省人民医院收治的高程序性死亡配体 1 表达、一般状况良好的 NSCLC 患者接受一线 ICIs 单药治疗的临床资料。转移部位包括肝、骨、脑、肾上腺、胸膜和对侧肺。采用 Kaplan-Meier 法比较不同转移部位和转移负荷之间的无进展生存期（PFS）和总生存期（OS）。评估不同单个转移部位的器官特异性疾病控制率（OSDCR）。
符合标准的 NSCLC 患者 40 例。存在肝转移与较短的 PFS（3.1 个月比 15.5 个月，P=0.0005）和 OS（11.1 个月比未达到，P=0.0016）显著相关。此外，骨转移患者的 PFS 更倾向于缩短（4.2 个月比 15.5 个月，P=0.0532），而不是 OS（P=0.6086）。此外，脑转移患者局部治疗的应用可能会使 PFS 略有延长（15.5 个月比 4.3 个月，P=0.1894）。转移器官越多，PFS 越差（P=0.0052），OS 越差（P=0.0791）。肝转移或骨转移与更多转移器官相关（Phi[ϕ]：0.516，P=0.001）。OSDCR 最高的是肺（17/17），最低的是肝（4/1）。
不同解剖部位的转移可能与 NSCLC 患者接受 ICIs 单药治疗的不同临床结局和局部肿瘤反应相关。ICIs 单药治疗在肝转移和骨转移患者中的疗效有限，因此此类转移患者可能需要更积极的联合治疗策略。
