微波消融联合载药微球支气管动脉化疗栓塞术后免疫治疗用于晚期非小细胞肺癌的维持治疗：一项回顾性单中心队列研究
Maintenance treatment of immunotherapy after microwave ablation plus drug-eluting bead bronchial arterial chemoembolization for advanced non-small cell lung cancer: a retrospective single-center cohort study.
作者信息
Xu Sheng, Bie Zhi-Xin, Li Yuan-Ming, Qi Jing, Peng Jin-Zhao, Li Xiao-Guang
机构信息
Department of Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.
Department of Neurology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
出版信息
Quant Imaging Med Surg. 2024 May 1;14(5):3473-3488. doi: 10.21037/qims-23-1876. Epub 2024 Apr 8.
BACKGROUND
The combination therapy of immunotherapy and drug-eluting bead bronchial artery chemoembolization (DEB-BACE) or microwave ablation (MWA) has been attempted as an effective and safe approach for advanced non-small cell lung cancer (NSCLC). However, the outcomes of immunotherapy plus multiple interventional techniques for advanced NSCLC remain unclear. This retrospective study thus aimed to investigate the effectiveness and safety of the maintenance treatment of programmed cell death protein 1 (PD-1) blockade after MWA plus DEB-BACE for advanced NSCLC.
METHODS
This retrospective cohort study consists of 95 patients with advanced NSCLC who were treated with DEB-BACE between April 2017 and October 2022 and who were allocated to three groups: group A (MWA + DEB-BACE + PD-1 blockade; n=15), group B (MWA + DEB-BACE; n=25), and group C (DEB-BACE alone; n=55). The adverse events (AEs) were compared between the three groups. The outcomes were compared via Kaplan-Meier methods, including median progression-free survival (PFS) and overall survival (OS). Survival analyses were performed via the univariate and multivariate analyses to investigate the prognostic predictors.
RESULTS
The overall incidence of AEs in the groups A-C was 53.3% (8/15), 36.0% (9/25), and 32.7% (18/55), respectively, which did not represent a significant difference (P=0.42). No severe AEs (SAEs) occurred. Group A, compared with group B and group C, had a significantly longer estimated median PFS (33.0 7.0 3.0 months; P<0.001) and OS (33.0 13.0 6.0 months; P=0.002). PD-1 blockade (P=0.006), tumor number (P=0.01), and DEB-BACE/bronchial artery infusion (BAI) chemotherapy cycles (P=0.04) were identified as the predictors of PFS, while the predictors of OS were PD-1 blockade (P<0.001), number of metastases (P<0.001), tumor diameter (P<0.001), and DEB-BACE/BAI cycles (P=0.02).
CONCLUSIONS
Compared with that of advanced NSCLC treated with MWA plus DEB-BACE or DEB-BACE alone, the maintenance treatment of immunotherapy after MWA plus DEB-BACE might provide a superior prognosis without increasing the risk of AEs.
背景
免疫疗法与载药微球支气管动脉化疗栓塞术（DEB - BACE）或微波消融术（MWA）联合治疗已被尝试作为晚期非小细胞肺癌（NSCLC）的一种有效且安全的方法。然而，免疫疗法联合多种介入技术治疗晚期NSCLC的疗效仍不明确。因此，这项回顾性研究旨在探讨MWA加DEB - BACE治疗晚期NSCLC后程序性细胞死亡蛋白1（PD - 1）阻断维持治疗的有效性和安全性。
方法
这项回顾性队列研究纳入了95例晚期NSCLC患者，这些患者在2017年4月至2022年10月期间接受了DEB - BACE治疗，并被分为三组：A组（MWA + DEB - BACE + PD - 1阻断；n = 15），B组（MWA + DEB - BACE；n = 25），C组（单纯DEB - BACE；n = 55）。比较三组之间的不良事件（AE）。通过Kaplan - Meier方法比较结果，包括中位无进展生存期（PFS）和总生存期（OS）。通过单因素和多因素分析进行生存分析，以研究预后预测因素。
结果
A - C组AE的总体发生率分别为53.3%（8/15）、36.0%（9/25）和32.7%（18/55），差异无统计学意义（P = 0.42）。未发生严重AE（SAE）。与B组和C组相比，A组的估计中位PFS显著更长（33.0对7.0对3.0个月；P < 0.001）和OS（33.0对13.0对6.0个月；P = 0.002）。PD - 1阻断（P = 0.006）、肿瘤数量（P = 0.01）和DEB - BACE/支气管动脉灌注（BAI）化疗周期（P = 0.04）被确定为PFS的预测因素，而OS的预测因素为PD - 1阻断（P < 0.001）、转移灶数量（P < 0.001）、肿瘤直径（P < 0.001）和DEB - BACE/BAI周期（P = 0.02）。
结论
与单纯接受MWA加DEB - BACE或DEB - BACE治疗的晚期NSCLC相比，MWA加DEB - BACE后免疫疗法的维持治疗可能提供更好的预后，且不增加AE风险。
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