肺动脉与升主动脉直径比值进展对免疫检查点抑制剂治疗 NSCLC 患者预后的影响。

The impact of pulmonary artery to ascending aorta diameter ratio progression on the prognosis of NSCLC patients treated with immune checkpoint inhibitors.

机构信息

Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

Hubei Key Laboratory of Molecular Imaging, Wuhan, China.

出版信息

Front Immunol. 2024 Jan 29;15:1302233. doi: 10.3389/fimmu.2024.1302233. eCollection 2024.

DOI:10.3389/fimmu.2024.1302233

PMID:38348049

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10859503/

Abstract

BACKGROUND

Immunotherapy, represented by immune checkpoint inhibitors (ICIs), is a major breakthrough in cancer treatment. Studies have reported that the use of ICIs is associated with an increase in the pulmonary artery to ascending aorta diameter (PAD/AoD) ratio. However, the impact of PAD/AoD ratio progression on the prognosis of patients is unclear.

METHODS

This retrospective cohort study included patients with stage III or IV non-small cell lung cancer (NSCLC) treated with ICIs at the Wuhan Union Hospital between March 1, 2020, and September 1, 2022. The baseline and post-treatment PAD/AoD ratios of patients were evaluated through chest CT scans. The primary outcome of this study was overall survival (OS), while the secondary outcomes included progression-free survival (PFS), objective response rate (ORR) and disease control rate (DCR).

RESULTS

The PAD/AoD ratio increased after the initiation of ICIs (from 0.75 to 0.78; < 0.001). A total of 441 patients were divided into severe group (n=221) and non-severe group (n=220) according to the median increase of PAD/AoD ratio (1.06). Compared with the non-severe group, the severe group had a lower DCR (87.8% vs. 96.0%, = 0.005) and ORR (87.5% vs. 96.0%, = 0.063). Over the entire duration of follow-up (median 22.0 months), 85 (38.5%) patients in the severe group and 30 (7.3%) patients in the non-severe group died. An increased PAD/AoD ratio was associated with shorter PFS (Hazard ratio (HR): 1.48 [95% CI, 1.14 to 1.93]; = 0.003) and OS (HR: 3.50 [95% CI, 2.30 to 5.30]; < 0.001). Similar results were obtained across subgroups.

CONCLUSIONS

ICI treatment exacerbates an increase in the PAD/AoD ratio in patients with cancer, and greater increase in the PAD/AoD ratio was associated with a worse prognosis. PAD/AoD ratio could be a biomarker to stratify prognosis of NSCLC patients treated with ICIs.

摘要

背景

免疫疗法，以免疫检查点抑制剂（ICIs）为代表，是癌症治疗的重大突破。研究报告称，ICI 的使用与肺动脉与升主动脉直径比（PAD/AoD）的增加有关。然而，PAD/AoD 比值的进展对患者预后的影响尚不清楚。

方法

本回顾性队列研究纳入了 2020 年 3 月 1 日至 2022 年 9 月 1 日期间在武汉协和医院接受 ICIs 治疗的 III 或 IV 期非小细胞肺癌（NSCLC）患者。通过胸部 CT 扫描评估患者的基线和治疗后 PAD/AoD 比值。本研究的主要结局是总生存期（OS），次要结局包括无进展生存期（PFS）、客观缓解率（ORR）和疾病控制率（DCR）。

结果

ICI 治疗后 PAD/AoD 比值升高（从 0.75 升至 0.78； < 0.001）。根据 PAD/AoD 比值增加的中位数（1.06），将 441 名患者分为严重组（n=221）和非严重组（n=220）。与非严重组相比，严重组的 DCR（87.8%比 96.0%， = 0.005）和 ORR（87.5%比 96.0%， = 0.063）较低。在整个随访期间（中位 22.0 个月），严重组有 85（38.5%）例患者死亡，而非严重组有 30（7.3%）例患者死亡。增加的 PAD/AoD 比值与较短的 PFS（风险比（HR）：1.48[95%置信区间，1.14 至 1.93]； = 0.003）和 OS（HR：3.50[95%置信区间，2.30 至 5.30]； < 0.001）相关。亚组分析也得到了类似的结果。