Centre Léon Bérard, Lyon, France.
Biostatistical Unit, Centre Léon Bérard, Lyon, France.
Lung Cancer. 2023 Aug;182:107280. doi: 10.1016/j.lungcan.2023.107280. Epub 2023 Jun 16.
Lung cancer survivors are at high risk of developing a second primary cancer (SPC). We explored the Unicancer Epidemiology Strategy Medical-Economics for advanced or metastatic lung cancer (AMLC) database to assess the impact of immune checkpoint inhibitors (ICI) on the risk of SPC in patients with advanced/metastatic lung cancer.
This retrospective study used data from patients with AMLC, with treatment initiated between January 1st 2015 and December 31st 2018. Patients with lung cancer as the second primary cancer were excluded and a 6-months landmark threshold was applied to exclude patients with synchronous SPC, patients dead without SPC or with a follow-up inferior to 6 months. A propensity score (PS) was calculated on the following baseline covariates: Age at locally advanced or metastatic diagnosis, sex, smoking status, metastatic status, performance status and histological type. The inverse probability of treatment weighting approach was used on the analyses aiming to assess the impact of ICI administered for AMLC, on the risk of occurrence of SPC.
Among the 10 796 patients, 148 (1.4%) patients had a diagnosis of SPC in a median interval of 22 (min-max: 7-173) months. All the patients (100%) with locally advanced or metastatic LC received at least one systemic treatment including (chemotherapy regimen (n = 9 851, 91.2%); ICI (n = 4 648, 43.0%); targeted treatment (n = 3 500; 32.4%). 40 (0.9%) SPC were reported in the 4 648 patients with metastatic LC treated with ICI vs 108 (1.7%) out of the 6 148 who did not receive immunotherapy (p < 0.0001). The multivariate analysis identified that treatment with ICI in patients with AMLC is associated with a reduced risk of SPC (HR = 0.40, 95% CI 0.27-0.58).
Treatment with ICI in AMLC patients was associated with a significantly reduced risk of SPC. Prospective studies are required to confirm these results.
肺癌幸存者患第二原发癌（SPC）的风险很高。我们探索了 Unicancer 流行病学策略医学经济学（Epidemiology Strategy Medical-Economics）针对晚期或转移性肺癌（AMLC）数据库，以评估免疫检查点抑制剂（ICI）对接受 AMLC 治疗的患者 SPC 风险的影响。
这项回顾性研究使用了 2015 年 1 月 1 日至 2018 年 12 月 31 日期间接受治疗的 AMLC 患者的数据。排除了以肺癌为第二原发癌的患者，并应用 6 个月的时间阈值排除了同时发生 SPC、无 SPC 死亡或随访时间不足 6 个月的患者。在以下基线协变量上计算倾向评分（PS）：局部晚期或转移性诊断时的年龄、性别、吸烟状况、转移状态、表现状态和组织学类型。采用逆概率治疗加权法（Inverse probability of treatment weighting approach）进行分析，旨在评估 AMLC 中 ICI 的治疗对 SPC 发生风险的影响。
在 10796 名患者中，148 名（1.4%）患者在中位数为 22 个月（最小-最大：7-173）的时间间隔内诊断出 SPC。所有（100%）局部晚期或转移性 LC 患者均接受了至少一种全身治疗，包括（化疗方案（n=9851，91.2%）；ICI（n=4648，43.0%）；靶向治疗（n=3500，32.4%）。在接受 ICI 治疗的 4648 名转移性 LC 患者中报告了 40 例（0.9%）SPC，而未接受免疫治疗的 6148 名患者中报告了 108 例（1.7%）（p<0.0001）。多变量分析确定，在 AMLC 患者中接受 ICI 治疗与 SPC 风险降低相关（HR=0.40，95%CI 0.27-0.58）。
在 AMLC 患者中接受 ICI 治疗与 SPC 风险显著降低相关。需要前瞻性研究来证实这些结果。
