Komiya Takefumi, Takamori Shinkichi, Shimokawa Mototsugu
Division of Hematology and Oncology, University at Buffalo, Buffalo, NY, USA.
Division of Hematology and Oncology, Penn State Cancer Institute, Penn State College of Medicine, Hershey, PA 17033, USA.
World J Oncol. 2023 Aug;14(4):234-245. doi: 10.14740/wjon1625. Epub 2023 Jul 12.
Immunotherapy has become a key component of systemic therapy in stage IV non-small cell lung cancer (NSCLC). However, there have been conflicting reports of its efficacy in patients with liver metastasis (LM).
Using National Cancer Database (NCDB), patients who have been diagnosed and treated at Commission on Cancer- participating US institutions were screened for analysis. Selection criteria included clinical stage IV NSCLC, available cTNM stage information, overall survival (OS) with at least 1 month, and diagnosis between 2015 and 2017. They were grouped based on status of LM as well as use of immunotherapy. Clinical characteristics were collected and their association with LM/immunotherapy was analyzed. Impact of immunotherapy on OS was examined according to LM status. Propensity score matching (PSM) analysis was also conducted.
A total of 83,479 including 18,497 LM-positive and 64,982 LM-negative patients met the study criteria. Presence of LM was associated with a number of clinical variables such as younger age, male sex, and chemotherapy. OS in patients with LM was significantly worse than that in those without LM (median OS, 5.0 vs. 8.8 months; hazard ratio (HR), 1.46; log-rank, P < 0.0001). Significant OS benefit from immunotherapy was observed in both LM-positive (median OS, 4.1 vs. 9.0 months; HR, 0.62; P < 0.0001) and negative groups (median OS, 7.2 vs. 15.6 months; HR, 0.64; P < 0.0001).
Immunotherapy benefited similarly to the survival of metastatic NSCLC patients regardless of with or without LM. Further research to validate the result would be warranted.
免疫疗法已成为IV期非小细胞肺癌（NSCLC）全身治疗的关键组成部分。然而，关于其在肝转移（LM）患者中的疗效报告存在矛盾。
利用国家癌症数据库（NCDB），筛选在美国癌症委员会参与机构诊断和治疗的患者进行分析。选择标准包括临床IV期NSCLC、可用的cTNM分期信息、至少1个月的总生存期（OS）以及2015年至2017年期间的诊断。根据LM状态以及免疫疗法的使用情况对患者进行分组。收集临床特征并分析其与LM/免疫疗法的关联。根据LM状态检查免疫疗法对OS的影响。还进行了倾向评分匹配（PSM）分析。
共有83479名患者符合研究标准，其中18497名LM阳性患者和64982名LM阴性患者。LM的存在与一些临床变量相关，如年龄较小、男性以及化疗。LM患者的OS明显差于无LM患者（中位OS，5.0个月对8.8个月；风险比（HR），1.46；对数秩检验，P<0.0001）。在LM阳性组（中位OS，4.1个月对9.0个月；HR，0.62；P<0.0001）和阴性组（中位OS，7.2个月对15.6个月；HR，0.64；P<0.0001）中均观察到免疫疗法对OS有显著益处。
无论有无LM，免疫疗法对转移性NSCLC患者的生存益处相似。有必要进行进一步研究以验证该结果。
