Lim Jeong Uk, Kang Hye Seon, Yeo Chang Dong, Kim Ju Sang, Kim Sung Kyoung, Kim Jin Woo, Kim Seung Joon, Lee Sang Haak
Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 10, 63-ro, Yeongdeungpo-gu, Seoul 03083, Republic of Korea.
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Ther Adv Med Oncol. 2024 Sep 25;16:17588359241281480. doi: 10.1177/17588359241281480. eCollection 2024.
Many patients with lung cancer have underlying chronic lung diseases. We assume that baseline lung functions might also affect the prognosis of non-small cell lung cancer (NSCLC) patients receiving immunotherapy.
We aimed to assess the impact of pretreatment clinical parameters, including lung function measures such as forced vital capacity (FVC), on the prognosis of patients with NSCLC following immune checkpoint inhibitors (ICIs) therapy.
Retrospective multicenter study.
Study subjects were consecutively selected from a multicenter cohort of patients with NSCLC who were undergoing immunotherapy. Patients were selected regardless of their initial cancer stage and prior treatment. The primary outcome was immunotherapy-related overall survival (iOS), defined as the duration from the initiation of immunotherapy to the time patients were censored. Spirometry values were acquired before bronchodilator application and were performed within the year before the first ICI treatment.
We selected 289 patients for evaluation. The median iOS was 10.9 months (95% confidence interval (CI), 7.5-14.3). Programmed death-ligand 1 (PD-L1) expression, tested by SP263, was <1% in 20.9%, 1%-49% in 44.3%, and ⩾50% in 32.6% of the patients. ICI was used most often as second-line treatment (70.2%), followed by first line (13.1%), and third line (11.4%). In the Kaplan-Meier analysis, the median iOS of the low FVC group was significantly shorter than that in the preserved FVC group (6.10 (95% CI, 4.45-7.76) months vs 14.40 (95% CI, 10.61-18.34) months, < 0.001)). A Cox regression analysis for iOS showed that age, poor performance status, PD-L1 expression measured by SP263, stage at diagnosis, and FVC (% predicted) were independent predictive factors. When we replaced FVC (%) in the multivariable analysis with forced expiratory volume in 1 s (%), diffusing lung capacity for carbon monoxide (DLco; %), or DLco (absolute), each of the pulmonary function factors showed a significant association with iOS.
Pre-immunotherapy FVC (%) predicted immunotherapy-related outcomes in NSCLC patients, regardless of initial stage at diagnosis and prior treatment modalities.
许多肺癌患者患有潜在的慢性肺部疾病。我们假设基线肺功能可能也会影响接受免疫治疗的非小细胞肺癌（NSCLC）患者的预后。
我们旨在评估包括用力肺活量（FVC）等肺功能指标在内的治疗前临床参数对免疫检查点抑制剂（ICI）治疗后NSCLC患者预后的影响。
回顾性多中心研究。
研究对象连续选自正在接受免疫治疗的NSCLC多中心队列患者。入选患者不考虑其初始癌症分期和既往治疗情况。主要结局是免疫治疗相关总生存期（iOS），定义为从免疫治疗开始至患者被 censored 的时间。在应用支气管扩张剂前获取肺量计值，且在首次ICI治疗前一年内进行。
我们选择了289例患者进行评估。iOS的中位数为10.9个月（95%置信区间（CI），7.5 - 14.3）。通过SP263检测的程序性死亡配体1（PD-L1）表达，20.9%的患者<1%，44.3%的患者为1% - 49%，32.6%的患者⩾50%。ICI最常作为二线治疗使用（70.2%），其次是一线治疗（13.1%）和三线治疗（11.4%）。在Kaplan-Meier分析中，低FVC组的iOS中位数显著短于FVC保留组（6.10（95%CI，4.45 - 7.76）个月对14.40（95%CI，10.61 - 18.34）个月，<0.001）。对iOS的Cox回归分析表明，年龄、较差的体能状态、通过SP263检测的PD-L1表达、诊断时的分期以及FVC（预测百分比）是独立的预测因素。当我们在多变量分析中用1秒用力呼气量（%）、一氧化碳弥散量（DLco；%）或DLco（绝对值）替代FVC（%）时，每个肺功能因素均与iOS显示出显著相关性。
免疫治疗前的FVC（%）可预测NSCLC患者的免疫治疗相关结局，无论诊断时的初始分期和既往治疗方式如何。
