Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada.
Department of Radiation Oncology, Simcoe Muskoka Regional Cancer Centre, Barrie, ON, Canada.
J Neurooncol. 2024 Apr;167(2):275-283. doi: 10.1007/s11060-024-04603-8. Epub 2024 Mar 25.
We report outcomes following spine stereotactic body radiotherapy (SBRT) in metastatic non-small cell lung cancer (NSCLC) and the significance of programmed death-ligand 1 (PD-L1) status, epidermal growth factor receptor (EGFR) mutation and timing of immune check point inhibitors (ICI) on local failure (LF).
165 patients and 389 spinal segments were retrospectively reviewed from 2009 to 2021. Baseline patient characteristics, treatment and outcomes were abstracted. Primary endpoint was LF and secondary, overall survival (OS) and vertebral compression fracture (VCF). Multivariable analysis (MVA) evaluated factors predictive of LF and VCF.
The median follow-up and OS were: 13.0 months (range, 0.5-95.3 months) and 18.4 months (95% CI 11.4-24.6). 52.1% were male and 76.4% had adenocarcinoma. Of the 389 segments, 30.3% harboured an EGFR mutation and 17.0% were PD-L1 ≥ 50%. The 24 months LF rate in PD-L1 ≥ 50% vs PD-L1 < 50% was 10.7% vs. 38.0%, and in EGFR-positive vs. negative was 18.1% vs. 30.0%. On MVA, PD-L1 status of ≥ 50% (HR 0.32, 95% CI 0.15-0.69, p = 0.004) significantly predicted for lower LF compared to PD-L1 < 50%. Lower LF trend was seen with ICI administration peri and post SBRT (HR 0.41, 95% CI 0.16-1.05, p = 0.062). On MVA, polymetastatic disease (HR 3.28, 95% CI 1.84-5.85, p < 0.0001) and ECOG ≥ 2 (HR 1.87, 95% CI 1.16-3.02, p = 0.011) significantly predicted for worse OS and absence of baseline VCF predicted for lower VCF rate (HR 0.20, 95% CI 0.10-0.39, p < 0.0001).
We report a significant association of PD-L1 ≥ 50% status on improved LC rates from spine SBRT in NSCLC patients.
我们报告了在转移性非小细胞肺癌（NSCLC）中接受脊柱立体定向体放射治疗（SBRT）的结果，以及程序性死亡配体 1（PD-L1）状态、表皮生长因子受体（EGFR）突变和免疫检查点抑制剂（ICI）的时机对局部失败（LF）的意义。
回顾性分析了 2009 年至 2021 年期间的 165 名患者和 389 个脊柱节段。提取基线患者特征、治疗和结果。主要终点是 LF，次要终点是总生存（OS）和椎体压缩性骨折（VCF）。多变量分析（MVA）评估了 LF 和 VCF 的预测因素。
中位随访时间和 OS 分别为：13.0 个月（范围，0.5-95.3 个月）和 18.4 个月（95%CI 11.4-24.6）。52.1%为男性，76.4%为腺癌。389 个节段中，30.3%存在 EGFR 突变，17.0% PD-L1 表达≥50%。PD-L1 表达≥50%组与 PD-L1 表达<50%组 24 个月 LF 率分别为 10.7%和 38.0%，EGFR 阳性组与阴性组分别为 18.1%和 30.0%。多变量分析显示，PD-L1 表达≥50%（HR 0.32，95%CI 0.15-0.69，p=0.004）与 PD-L1 表达<50%相比，显著降低 LF 风险。SBRT 围手术期和术后给予 ICI 治疗也有降低 LF 的趋势（HR 0.41，95%CI 0.16-1.05，p=0.062）。多变量分析显示，多发性转移疾病（HR 3.28，95%CI 1.84-5.85，p<0.0001）和 ECOG 评分≥2（HR 1.87，95%CI 1.16-3.02，p=0.011）显著预测 OS 更差，基线无 VCF 预测 VCF 发生率更低（HR 0.20，95%CI 0.10-0.39，p<0.0001）。
我们报告了 NSCLC 患者脊柱 SBRT 后 PD-L1 表达≥50%状态与改善局部控制率之间的显著关联。
