First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
Department of Respiratory Medicine, Nagano Red Cross Hospital, Nagano, Japan.
Oncology. 2023;101(7):425-434. doi: 10.1159/000531324. Epub 2023 Jul 7.
Combination immunotherapy is widely used in clinical practice as the first-line treatment for advanced non-small-cell lung cancer (NSCLC). However, predictive factors associated with long-term response to combination immunotherapy have not been well investigated. Herein, we compared the clinical findings, including systemic inflammatory nutritional biomarkers, between responders and nonresponders to combination immunotherapy. In addition, we investigated the predictive factors associated with long-term response to combination immunotherapy.
This study included a total of 112 previously untreated advanced NSCLC patients who received combination immunotherapy at eight institutions in Nagano prefecture between December 2018 and April 2021. The responders were defined as those who achieved progression-free survival for 9 months or longer with combined immunotherapy. We evaluated predictive factors associated with long-term response, and the favorable prognostic predictors associated with overall survival (OS) using statistical analyses.
The responder and nonresponder groups included 54 and 58 patients, respectively. Compared with the nonresponder group, the responder group had significantly younger age (p = 0.046), higher prognostic nutritional index (44.8 vs. 40.7, p = 0.010), lower C-reactive protein/albumin ratio (CAR) (0.17 vs. 0.67, p = 0.001), and a higher rate of complete plus partial response (83.3% vs. 34.5%, p < 0.001). The area under the curve and optimal cut-off value for CAR were 0.691 and 0.215, respectively. The CAR and best objective response were identified as independent favorable prognostic predictors associated with OS in the multivariate analyses.
The CAR and best objective response were suggested to be useful predictors of long-term response in NSCLC patients who received combination immunotherapy.
联合免疫疗法已广泛应用于临床实践，作为晚期非小细胞肺癌（NSCLC）的一线治疗方法。然而，与联合免疫治疗长期反应相关的预测因素尚未得到很好的研究。在此，我们比较了应答者和无应答者对联合免疫治疗的临床发现，包括全身炎症营养生物标志物。此外，我们还研究了与联合免疫治疗长期反应相关的预测因素。
本研究共纳入 2018 年 12 月至 2021 年 4 月在长野县 8 家机构接受联合免疫治疗的 112 例未经治疗的晚期 NSCLC 患者。应答者定义为联合免疫治疗后无进展生存 9 个月或更长时间的患者。我们使用统计学分析评估与长期反应相关的预测因素以及与总生存（OS）相关的有利预后预测因素。
应答者组和无应答者组分别包括 54 例和 58 例患者。与无应答者组相比，应答者组年龄较小（p = 0.046），预后营养指数较高（44.8 比 40.7，p = 0.010），C 反应蛋白/白蛋白比值较低（CAR）（0.17 比 0.67，p = 0.001），完全和部分缓解率较高（83.3%比 34.5%，p < 0.001）。CAR 的曲线下面积和最佳截断值分别为 0.691 和 0.215。在多变量分析中，CAR 和最佳客观缓解被确定为与 OS 相关的独立有利预后预测因素。
CAR 和最佳客观缓解被认为是接受联合免疫治疗的 NSCLC 患者长期反应的有用预测因素。
