Sumiyoshi Kyoko, Yatsushige Hiroshi, Shigeta Keigo, Aizawa Yuuki, Fujino Asuka, Ishijima Nozomi, Hayakawa Takanori
Division of Neurosurgery, Division of Neurosurgery, National Disaster Medical Center, 3256 Midori-cho, Tachikawa, Tokyo, Japan.
Heliyon. 2024 Sep 19;10(18):e38128. doi: 10.1016/j.heliyon.2024.e38128. eCollection 2024 Sep 30.
Although the treatment of nonsmall cell lung cancer (NSCLC) has rapidly progressed recently, there is little evidence of treatment for patients with symptomatic brain metastases (BM) and poor performance status (PS). However, in symptomatic BM patients, appropriate upfront intracranial treatment can often lead to rapid improvement in PS and effective systemic therapy. Thus, this study investigated the prognostic factors for the survival of poor PS NSCLC patients with synchronous BM.
Data of patients with BM and Karnofsky PS (KPS) ≤70 at the first diagnosis of NSCLC who were treated in our hospital between January 2017 and December 2021 were reviewed. Patient survival was compared among patients stratified by type of first-line regimen of systemic treatment. Correlations between patient characteristics and survival were examined.
Fifty patients receiving aggressive treatment were enrolled. The median survival times for tyrosine kinase inhibitor (TKI), immune checkpoint inhibitor (ICI), and chemotherapy alone groups were 19 (95 % confidence interval [CI], 2.8-68.5), 19 (3.0-62.0), and 13 (1.2-24.8) months, respectively. Survival in the TKI and ICI groups was significantly longer than in the chemotherapy alone group (p = 0.046, TKI vs. chemo; p = 0.022, ICI vs. chemo; p = 0.023). Both sex and type of systemic treatment correlated to survival time on univariate analysis. Chemotherapy alone for systemic treatment [p = 0.034; hazard ratio (HR), 0.44 (0.20-0.94)] remained significant for predicting overall survival in the multivariate analysis.
Even in patients with poor PS and BM at the initial diagnosis of NSCLC, the ICI group had a survival time comparable to that of the TKI group when combined with tailor-made intracranial treatment. There is a subgroup in the patient population that was previously considered unsuitable for ICI, whose PS improves with individualized intracranial treatment, and who may benefit from immunotherapy.
尽管非小细胞肺癌（NSCLC）的治疗近来进展迅速，但对于有症状的脑转移（BM）且体能状态（PS）较差的患者，治疗证据仍然很少。然而，在有症状的BM患者中，适当的初始颅内治疗通常可使PS迅速改善并实现有效的全身治疗。因此，本研究调查了同步性BM的PS较差的NSCLC患者生存的预后因素。
回顾了2017年1月至2021年12月在我院首次诊断为NSCLC时伴有BM且卡诺夫斯基PS（KPS）≤70的患者数据。对按全身治疗一线方案类型分层的患者的生存情况进行比较。检查患者特征与生存之间的相关性。
纳入了50例接受积极治疗的患者。酪氨酸激酶抑制剂（TKI）组、免疫检查点抑制剂（ICI）组和单纯化疗组的中位生存时间分别为19（95%置信区间[CI]，2.8 - 68.5）、19（3.0 - 62.0）和13（1.2 - 24.8）个月。TKI组和ICI组的生存期显著长于单纯化疗组（p = 0.046，TKI组与化疗组对比；p = 0.022，ICI组与化疗组对比；p = 0.023）。单因素分析显示，性别和全身治疗类型均与生存时间相关。在多因素分析中，单纯化疗用于全身治疗[p = 0.034；风险比（HR），0.44（0.20 - 0.94）]对于预测总生存仍然具有显著性。
即使在NSCLC初始诊断时PS较差且有BM的患者中，ICI组在联合定制的颅内治疗时生存期与TKI组相当。在先前被认为不适合ICI的患者群体中有一个亚组，其PS通过个体化颅内治疗得到改善，且可能从免疫治疗中获益。
