Patel Krishna H, Alpert Naomi, Tuminello Stephanie, Taioli Emanuela
Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
NYU Grossman School of Medicine, New York, NY, USA.
Transl Lung Cancer Res. 2023 Jun 30;12(6):1210-1220. doi: 10.21037/tlcr-22-682. Epub 2023 Jun 13.
Immunotherapy response rates in metastatic non-small cell lung cancer (NSCLC) are low and survival varies significantly. Factors like age, sex, race, and histology may modulate immunotherapy response. Existing analyses are limited to clinical trials, with limited generalizability, and meta-analyses where adjustment for potential confounders cannot be performed. Here, we conduct a cohort study with patient-level analysis to explore how personal and clinical characteristics moderate chemoimmunotherapy effectiveness in metastatic NSCLC.
Stage IV NSCLC patients diagnosed in 2015 were drawn from Surveillance Epidemiology, and End Results-Medicare linked data. Receipt of chemoimmunotherapy and overall survival (OS) were the primary predictor and outcome of interest respectively. Multivariable Cox-proportional hazards regression and propensity-score matching were performed to evaluate the effectiveness of immunotherapy addition to chemotherapy.
From a total of 1,471 patients, 349 (24%) received chemoimmunotherapy and 1,122 (76%) received chemotherapy alone. Survival was significantly better among those treated with chemoimmunotherapy compared to those receiving chemotherapy alone [adjusted hazard ratio (HR) =0.72, 95% confidence interval (CI): 0.63-0.83]. Males saw significantly better OS from chemoimmunotherapy (HR =0.62, 95% CI: 0.51-0.75) than females (HR =0.81, 95% CI: 0.65-1.01, P=0.0557). After propensity-score matching, the effect of chemoimmunotherapy was borderline significant according to sex (P =0.0414), but not age or histology.
Males may benefit more from chemoimmunotherapy, but there is limited evidence suggesting age, histology, race, and comorbidities contribute to differences in effectiveness. Future research should elucidate who responds best to chemoimmunotherapy, and further analyses of characteristics like race can inform how to tailor different treatment regimens to distinct patient subpopulations.
转移性非小细胞肺癌（NSCLC）的免疫治疗反应率较低，生存率差异显著。年龄、性别、种族和组织学等因素可能会调节免疫治疗反应。现有分析仅限于临床试验，其普遍性有限，且在荟萃分析中无法对潜在混杂因素进行调整。在此，我们进行了一项队列研究，并进行患者水平分析，以探讨个人和临床特征如何影响转移性NSCLC中化疗免疫治疗的效果。
2015年诊断为IV期NSCLC的患者来自监测流行病学和最终结果-医疗保险关联数据。接受化疗免疫治疗和总生存期（OS）分别是主要预测因素和感兴趣的结果。进行多变量Cox比例风险回归和倾向评分匹配，以评估化疗联合免疫治疗的效果。
在总共1471名患者中，349名（24%）接受了化疗免疫治疗，1122名（76%）仅接受了化疗。与仅接受化疗的患者相比，接受化疗免疫治疗的患者生存率显著更高[调整后的风险比（HR）=0.7, 95%置信区间（CI）：0.63-0.83]。男性接受化疗免疫治疗后的总生存期（HR =0.62, 95% CI: 0.51-0.75）明显优于女性（HR =0.81, 95% CI: 0.65-1.01, P=0.0557）。倾向评分匹配后，化疗免疫治疗的效果按性别接近显著（P =0.0414），但按年龄或组织学则不显著。
男性可能从化疗免疫治疗中获益更多，但仅有有限证据表明年龄、组织学、种族和合并症会导致疗效差异。未来的研究应阐明谁对化疗免疫治疗反应最佳，对种族等特征的进一步分析可为如何针对不同患者亚群制定不同治疗方案提供参考。
