CHU Nantes, Medical Oncology, Nantes Université, Nantes, France.
Nantes Université, CHU Nantes, Pôle Hospitalo-Universitaire 11: Santé Publique, Clinique des données, Nantes, France.
Clin Lung Cancer. 2024 May;25(3):244-253.e2. doi: 10.1016/j.cllc.2023.12.004. Epub 2023 Dec 13.
The prognostic impact of TP53 mutations in advanced or metastatic nonsquamous non-small-cell lung cancer (nsNSCLC) patients treated with chemotherapy and/or immune checkpoint inhibitors (ICI) remains unclear.
We retrospectively collected data from patients with nsNSCLC treated in the first line from January 2018 to May 2021. The patient was separated into 2 groups according to their TP53 mutation status (wt vs. mut). Survival was estimated through the Kaplan-Meier method and compared by log-rank test.
Of 220 patients included, 126 were in the mutTP53 group, and 94 were in the wtTP53wt group. Median OS (mOS) was not significantly different between the mutTP53 and wtTP53 groups [17.5 months (95% confidence interval (CI), 11.3-21.5) vs. 9.5 months (95% CI, 7.4-14.2), (P = .051)]. In subgroup analyses, the mutTP53 group treated with ICI had a significantly improved mOS compared to the wtTP53 group [(24.7 months (95% CI, 20.8-not reach) vs. 12.0 months (95% CI, 4.7-not reach), (P = .017)] and mPFS [(9.6 months (95% CI, 5.8-not reach) vs. 3.2 months (95% CI, 1.3-13.8) (P = .048)]. There was no difference in terms of mOS and mPFS between the mutTP53 and the wtTP53 group treated by chemotherapy alone or combined with ICI.
TP53 mutation had no survival impact in the overall population, but is associated with better outcomes with ICI alone. These results suggest that patients with TP53 mutations could be treated with ICI alone, and wild-type patients could benefit from the addition of chemotherapy.
TP53 突变对接受化疗和/或免疫检查点抑制剂（ICI）治疗的晚期或转移性非鳞状非小细胞肺癌（nsNSCLC）患者的预后影响尚不清楚。
我们回顾性收集了 2018 年 1 月至 2021 年 5 月期间一线治疗的 nsNSCLC 患者的数据。根据 TP53 突变状态（wt 与 mut）将患者分为 2 组。通过 Kaplan-Meier 法估计生存情况，并通过对数秩检验进行比较。
在 220 例患者中，126 例为 mutTP53 组，94 例为 wtTP53wt 组。mutTP53 组与 wtTP53 组的中位总生存期（mOS）无显著差异[17.5 个月（95%置信区间（CI），11.3-21.5）与 9.5 个月（95% CI，7.4-14.2），（P =.051）]。亚组分析显示，接受 ICI 治疗的 mutTP53 组 mOS 显著优于 wtTP53 组[24.7 个月（95% CI，20.8-未达到）与 12.0 个月（95% CI，4.7-未达到），（P =.017）]和 mPFS[9.6 个月（95% CI，5.8-未达到）与 3.2 个月（95% CI，1.3-13.8），（P =.048）]。单独接受化疗或联合 ICI 治疗的 mutTP53 组与 wtTP53 组在 mOS 和 mPFS 方面无差异。
TP53 突变在总体人群中对生存无影响，但与单独接受 ICI 治疗的患者的预后相关。这些结果表明，TP53 突变的患者可以单独接受 ICI 治疗，野生型患者可以从化疗的加入中获益。
