广泛期小细胞肺癌患者的放疗与免疫治疗的临床结局和协同作用：一项真实世界研究。

Clinical outcomes and synergistic effect between radiotherapy and immunotherapy in patients with extensive-stage small cell lung cancer: a real-world study.

机构信息

Department of Pulmonary and Critical Care Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, No. 107 Wenhua Xilu, Jinan, 250012, Shandong, China.

Department of Respiratory Medicine, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, 70 Heping Road, Weihai, 264200, Shandong, China.

出版信息

BMC Cancer. 2024 Sep 30;24(1):1206. doi: 10.1186/s12885-024-12942-y.

DOI:10.1186/s12885-024-12942-y

PMID:39350057

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11441094/

Abstract

BACKGROUND

Patients with extensive-stage small cell lung cancer (ES-SCLC) experience significant therapeutic challenges and limited survival rates. This study aimed to investigate the efficacy of combining immunotherapy (IT) with chemotherapy (CT) for treating ES-SCLC and to explore the synergistic effect between radiotherapy (RT) and IT.

METHODS

This retrospective analysis examined patients with ES-SCLC who received treatment at three centers. Furthermore, propensity score-matched (PSM) analysis was conducted. The Kaplan‒Meier method and Cox proportional hazards regression were used to compare the survival outcomes.

RESULTS

A total of 257 eligible patients with ES-SCLC were included in the analysis. Among all patients, the median overall survival (mOS) was 18.0 m in the chemoimmunotherapy (CT + IT) group and 15.7 m in the CT group (p = 0.208). The median real-world progression-free survival (mrwPFS) was 7.7 m and 6.8 m (p = 0.043) in the CT + IT and CT group, respectively. Moreover, the mOS was 22.0 m in the chemoradiotherapy (CT + RT) group and 13.6 m in the CT group (p < 0.001). The mrwPFS was 7.4 m and 6.0 m (p = 0.175) in the CT + RT group and CT group, respectively. The multivariate analyses revealed that sex, liver metastasis and RT were independent prognostic factors for OS (p < 0.05), while liver metastasis and IT were found to be independent predictive factors of real-world progression-free survival (rwPFS) (p < 0.05). After PSM, the mOS was 23.2 m in the CT + IT group and 13.0 m in the CT group (p = 0.008). The mrwPFS was 7.3 m and 6.2 m (p = 0.096) in the CT + IT group and the CT group, respectively. Moreover, the mOS was 21.4 m in the CT + RT group and 12.5 m in the CT group (p < 0.001). The mrwPFS was 7.3 m and 5.2 m (p = 0.220) in the CT + RT group and the CT group, respectively. Additionally, our study revealed that in the PD-1 group, RT significantly improved patient survival (36.0 m vs. 15.8 m, p = 0.041).

CONCLUSION

An increasing number of treatment options are being explored for ES-SCLC, and CT is the cornerstone of treatment for this disease. Combining CT with IT and RT has demonstrated remarkable efficacy and excellent safety profiles, and such treatments are worthy of further exploration.

摘要

背景

广泛期小细胞肺癌（ES-SCLC）患者面临着重大的治疗挑战和有限的生存率。本研究旨在探讨免疫治疗（IT）联合化疗（CT）治疗 ES-SCLC 的疗效，并探索放疗（RT）与 IT 的协同作用。

方法

本回顾性分析纳入了在三个中心接受治疗的 ES-SCLC 患者。此外，还进行了倾向评分匹配（PSM）分析。采用 Kaplan-Meier 方法和 Cox 比例风险回归比较生存结局。

结果

共纳入 257 例符合条件的 ES-SCLC 患者。在所有患者中，化疗免疫治疗（CT+IT）组的中位总生存期（mOS）为 18.0 个月，CT 组为 15.7 个月（p=0.208）。CT+IT 组和 CT 组的中位真实世界无进展生存期（mrwPFS）分别为 7.7 个月和 6.8 个月（p=0.043）。此外，CT+RT 组的 mOS 为 22.0 个月，CT 组为 13.6 个月（p<0.001）。CT+RT 组和 CT 组的 mrwPFS 分别为 7.4 个月和 6.0 个月（p=0.175）。多因素分析显示，性别、肝转移和 RT 是 OS 的独立预后因素（p<0.05），而肝转移和 IT 是 rwPFS 的独立预测因素（p<0.05）。PSM 后，CT+IT 组的 mOS 为 23.2 个月，CT 组为 13.0 个月（p=0.008）。CT+IT 组和 CT 组的 mrwPFS 分别为 7.3 个月和 6.2 个月（p=0.096）。此外，CT+RT 组的 mOS 为 21.4 个月，CT 组为 12.5 个月（p<0.001）。CT+RT 组和 CT 组的 mrwPFS 分别为 7.3 个月和 5.2 个月（p=0.220）。此外，我们的研究表明，在 PD-1 组中，RT 显著改善了患者的生存（36.0 个月 vs. 15.8 个月，p=0.041）。