Zhou Shichao, Zhai Wanchen, Zhang Qian, Li Hui, Fan Yun
Department of Thoracic Medical Oncology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine, Chinese Academy of Sciences, Hangzhou, Zhejiang, China.
Department of Oncology, The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
Ther Adv Med Oncol. 2025 May 23;17:17588359251341158. doi: 10.1177/17588359251341158. eCollection 2025.
Chemoimmunotherapy has emerged as the standard first-line treatment for extensive-stage small cell lung cancer (ES-SCLC), improving survival outcomes. However, the role of prophylactic cranial irradiation (PCI) in the context of chemoimmunotherapy remains undefined.
This study aimed to evaluate the impact of PCI on overall survival (OS) in patients with ES-SCLC after chemoimmunotherapy administration.
Retrospective study.
This retrospective analysis included 261 patients with ES-SCLC treated with first-line chemoimmunotherapy between January 2019 and December 2023. All patients underwent MRI scans to confirm the absence of brain metastases. After 1:2 propensity score matching (PSM), 46 and 81 patients were assigned to the PCI and observation groups, respectively. The primary endpoint was OS, with additional exploration of progression-free survival (PFS), the cumulative incidence of intracranial metastases, and intracranial progression-free survival (iPFS).
After PSM, the two groups were well-balanced in baseline characteristics. Survival analysis showed a median OS of 19.9 months (95% confidence interval (CI): 11.8-28.0) in the PCI group and 15.6 months (12.3-18.9) in the observation group, without a significant difference (hazard ratio (HR) = 0.763 (95% CI: 0.484-1.206), log-rank = 0.265). PCI significantly reduced the risk of brain metastasis (Fine-Gray = 0.002), with 1-year cumulative incidence rates of 13.8% (3.4%-24.2%) in the PCI group and 53.4% (41.3%-65.6%) in the observation group. Subgroup analysis showed that for ES-SCLC patients achieving a partial response to initial chemoimmunotherapy, the PCI group had longer median OS (25.7 months (95% CI: 15.4-36.1) vs 19.4 months (15.4-23.4); HR = 0.502 (0.284-0.886); log-rank = 0.021).
PCI did not improve OS in ES-SCLC patients receiving first-line chemoimmunotherapy, while it may confer a survival benefit for patients who achieve remission following chemoimmunotherapy. In addition, PCI significantly reduced the incidence of brain metastases. These findings warrant further randomized studies for verification.
化疗免疫疗法已成为广泛期小细胞肺癌（ES-SCLC）的标准一线治疗方法，可改善生存结果。然而，预防性颅脑照射（PCI）在化疗免疫疗法中的作用仍不明确。
本研究旨在评估PCI对接受化疗免疫疗法的ES-SCLC患者总生存期（OS）的影响。
回顾性研究。
这项回顾性分析纳入了2019年1月至2023年12月期间接受一线化疗免疫疗法治疗的261例ES-SCLC患者。所有患者均接受MRI扫描以确认无脑转移。经过1:2倾向评分匹配（PSM）后，分别将46例和81例患者分配至PCI组和观察组。主要终点为OS，同时进一步探讨无进展生存期（PFS）、颅内转移累积发生率和无颅内进展生存期（iPFS）。
PSM后，两组的基线特征均衡。生存分析显示，PCI组的中位OS为19.9个月（95%置信区间（CI）：11.8 - 28.0），观察组为15.6个月（12.3 - 18.9），差异无统计学意义（风险比（HR）= 0.763（95% CI：0.484 - 1.206），对数秩检验 = 0.265）。PCI显著降低了脑转移风险（Fine-Gray检验 = 0.002），PCI组1年累积发生率为13.8%（3.4% - 24.2%），观察组为53.4%（41.3% - 65.6%）。亚组分析显示，对于初始化疗免疫疗法获得部分缓解的ES-SCLC患者，PCI组中位OS更长（25.7个月（95% CI：15.4 - 36.1）对19.4个月（15.4 - 23.4）；HR = 0.502（0.284 - 0.886）；对数秩检验 = 0.021）。
PCI未改善接受一线化疗免疫疗法的ES-SCLC患者的OS，但可能对化疗免疫疗法后获得缓解的患者有生存获益。此外，PCI显著降低了脑转移发生率。这些发现有待进一步的随机研究验证。
