Zhao Ke, Lu Shuangqing, Niu Jiling, Zhu Hui, Tian Yaru, Yu Jinming
Shandong University Cancer Center, Cheeloo College of Medicine, Shandong University, Jinan, 250117, Shandong, China.
Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Sciences, Jinan, 250117, China.
BMC Cancer. 2025 Mar 14;25(1):467. doi: 10.1186/s12885-025-13880-z.
Immunotherapy combined with chemotherapy has shown good results in the treatment of extensive-stage small cell lung cancer (ES-SCLC), but there are fewer clinical studies on elderly ES-SCLC patients. This study was aimed to evaluate the efficacy and safety of immunotherapy in combination with chemotherapy in elderly patients with ES-SCLC.
Elderly patients with ES-SCLC who were 70 years of age or older and were diagnosed at Shandong Cancer Hospital from May 20, 2020, to February 24, 2023, were included in this study. Overall survival (OS) and progression-free survival (PFS) were calculated via the Kaplan‒Meier method and compared via the log-rank test. In addition, the Cox regression model was used to analyze prognostic factors.
A total of 135 patients were included in this study; 82 patients were in the immunotherapy combined with chemotherapy (IO + ChT) group, and 53 patients were in the chemotherapy alone (ChT-alone) group. The median overall survival (mOS) for the entire patient cohort was 12.89 months, whereas the median progression-free survival (mPFS) was 7.21 months. There was a significant difference in mPFS (8.26 months vs. 6.59 months, P =.02) and no statistically significant difference in mOS (14.20 months vs. 11.44 months, P =.14) between the IO + ChT and ChT-alone groups. The incidence of grade ≥ 3 adverse events in the IO + ChT group was not significantly different from that in the ChT-alone group. Moreover, we did not observe grade ≥ 3 immune-related adverse reactions. The univariate multifactorial analysis demonstrated that the absence of liver metastases at baseline and in female patients were favorable prognostic factors for OS, and the addition of immunotherapy was a favorable prognostic factor that improved overall survival in elderly patients with ES-SCLC. Subgroup analyses indicated that adding immunotherapy provided a survival benefit for patients with baseline brain metastases and baseline liver-free metastases.
Immunotherapy combined with chemotherapy can provide a survival benefit, and the addition of immunotherapy does not result in significant toxicity in elderly patients. The results of this study have important clinical implications for the future treatment of elderly patients with ES-SCLC.
免疫疗法联合化疗在广泛期小细胞肺癌（ES-SCLC）的治疗中已显示出良好效果，但针对老年ES-SCLC患者的临床研究较少。本研究旨在评估免疫疗法联合化疗在老年ES-SCLC患者中的疗效和安全性。
纳入2020年5月20日至2023年2月24日在山东省肿瘤医院确诊的70岁及以上的老年ES-SCLC患者。通过Kaplan-Meier法计算总生存期（OS）和无进展生存期（PFS），并通过对数秩检验进行比较。此外，使用Cox回归模型分析预后因素。
本研究共纳入135例患者；82例患者在免疫疗法联合化疗（IO+ChT）组，53例患者在单纯化疗（ChT-alone）组。整个患者队列的中位总生存期（mOS）为12.89个月，而中位无进展生存期（mPFS）为7.21个月。IO+ChT组与ChT-alone组之间的mPFS存在显著差异（8.26个月对6.59个月，P=0.02），而mOS无统计学显著差异（14.20个月对11.44个月，P=0.14）。IO+ChT组≥3级不良事件的发生率与ChT-alone组无显著差异。此外，我们未观察到≥3级免疫相关不良反应。单因素多因素分析表明，基线时无肝转移和女性患者是OS的有利预后因素，添加免疫疗法是改善老年ES-SCLC患者总生存期的有利预后因素。亚组分析表明，添加免疫疗法为基线有脑转移和基线无肝转移的患者提供了生存益处。
免疫疗法联合化疗可提供生存益处，且添加免疫疗法在老年患者中不会导致显著毒性。本研究结果对老年ES-SCLC患者的未来治疗具有重要的临床意义。
