同步寡转移和寡进展作为广泛期小细胞肺癌患者接受免疫检查点抑制剂与化疗联合治疗（HOT2301）的预后标志物
Synchronous Oligometastasis and Oligoprogression as a Prognostic Marker in Patients With Extensive-Stage SCLC Treated With a Combination of Immune-Checkpoint Inhibitor and Chemotherapy (HOT2301).
作者信息
Hashimoto Kana, Morinaga Daisuke, Asahina Hajime, Ishidoya Mina, Kikuchi Hajime, Yokouchi Hiroshi, Harada Toshiyuki, Honjo Osamu, Shigaki Ryota, Takashina Taichi, Fujita Yuka, Takahashi Mamoru, Kawai Yasutaka, Kida Ryotaro, Ito Kenichiro, Sukoh Noriaki, Takahashi Ayumu, Hommura Fumihiro, Ohhara Yoshihito, Furuta Megumi, Konno Satoshi, Hosomi Yukio, Oizumi Satoshi
机构信息
Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.
Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
出版信息
JTO Clin Res Rep. 2024 Sep 7;5(11):100715. doi: 10.1016/j.jtocrr.2024.100715. eCollection 2024 Nov.
INTRODUCTION
Oligometastasis and oligoprogression (OP) has not been adequately defined in extensive-stage SCLC (ES-SCLC) and may be a good indication for adding local treatment. Therefore, this multicenter study aimed to investigate the prognostic impact of oligometastasis and OP in ES-SCLC.
METHODS
We enrolled patients who received chemoimmunotherapy between September 2019 and June 2022. Patients were classified into oligometastasis and non-oligometastasis groups by determining the number of original tumor lesions and distant metastases (worsening or newly appearing lesions) at the time of initial diagnosis and disease progression after first-line treatment.
RESULTS
We retrospectively analyzed 265 consecutive patients with ES-SCLC. Synchronous oligometastasis (SOM) and OP was defined as less than or equal to five lesions in less than or equal to two organs, including lungs; 21.0% and 53.2% of patients had SOM and OP, respectively. Median progression-free survival was 5.8 months and 4.9 months in patients with and without SOM, respectively (hazard ratio [HR] = 0.72, 95% confidence interval [CI]: 0.51-1.02, = 0.065). Median overall survival was 20.5 months and 15.0 months in patients with and without SOM (HR = 0.58, 95% CI: 0.37-0.95, = 0.027) from the initiation of first-line treatment. The OP group revealed a better progression-free survival of 5.2 months (versus 3.2 mo, HR = 0.69, 95% CI: 0.50-0.96, = 0.026) and overall survival of 15.1 months (versus 7.5 mo, HR = 0.44, 95% CI: 0.29-0.66, = 0.027) from the initiation of second-line treatment compared with the non-OP group. The Lung Immune Prognostic Index score was significantly lower in the SOM and OP group.
CONCLUSIONS
ES-SCLC in patients with SOM and OP may be more indolent than that of the nonoligometastasis group, therefore, new treatment strategies, including the addition of local treatment, should be explored.
CLINICAL TRIAL REGISTRATION
This study was registered at UMIN-CTR (UMIN000053402).
引言
寡转移和寡进展（OP）在广泛期小细胞肺癌（ES-SCLC）中尚未得到充分定义，可能是增加局部治疗的良好指征。因此，这项多中心研究旨在探讨寡转移和OP对ES-SCLC患者预后的影响。
方法
我们纳入了2019年9月至2022年6月期间接受化疗免疫治疗的患者。通过确定初始诊断时以及一线治疗后疾病进展时的原发肿瘤病灶和远处转移（恶化或新出现的病灶）数量，将患者分为寡转移组和非寡转移组。
结果
我们回顾性分析了265例连续的ES-SCLC患者。同步寡转移（SOM）和OP被定义为在包括肺部在内的少于或等于两个器官中少于或等于五个病灶；分别有21.0%和53.2%的患者存在SOM和OP。有和没有SOM的患者的无进展生存期分别为5.8个月和4.9个月（风险比[HR]=0.72，95%置信区间[CI]：0.51-1.02，P=0.065）。从一线治疗开始，有和没有SOM的患者的总生存期分别为20.5个月和15.0个月（HR=0.58，95%CI：0.37-0.95，P=0.027）。与非OP组相比，OP组从二线治疗开始的无进展生存期更好，为5.2个月（对比3.2个月，HR=0.69，95%CI：0.50-0.96，P=0.026），总生存期为15.1个月（对比7.5个月，HR=0.44，95%CI：0.29-0.66，P=0.027）。SOM和OP组的肺免疫预后指数评分显著更低。
结论
有SOM和OP的ES-SCLC患者可能比非寡转移组的病情更惰性，因此，应探索包括增加局部治疗在内的新治疗策略。
临床试验注册
本研究已在日本大学医学信息网络临床试验注册中心（UMIN-CTR，UMIN000053402）注册。
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