Zou Yao, Chen Yichong, Zhou Xiaojuan, Gong Youling, Xu Yong, Zou Bingwen, Peng Feng, Huang Meijuan, Lu You, Liu Yongmei
Division of Thoracic Tumor Multimodality Treatment, Cancer Center, West China Hospital, Sichuan University, Chengdu, China.
West China Hospital Sichuan University, Meishan Hospital, Meishan, China.
Front Oncol. 2025 Aug 6;15:1611528. doi: 10.3389/fonc.2025.1611528. eCollection 2025.
We aimed to evaluate the efficacy of thoracic radiotherapy (TRT) combined with immune checkpoint inhibitors (ICIs) in patients with advanced non-small-cell lung cancer (NSCLC) in real-world clinical settings and identify predictive subgroups that may benefit most from this approach.
We retrospectively reviewed the medical records of patients with advanced NSCLC who were treated with ICIs at West China Hospital from January 2015 to May 2022.
A total of 302 patients with advanced NSCLC were included in this study. Among them, 54.3% (164/302) received ICIs in combination with TRT and were assigned to the TRT+ICIs group, while 45.7% (138/302) received ICIs alone and were assigned to the ICIs-only group. The median overall survival (OS) was significantly longer in the TRT+ICIs group (34.7 months) than in the ICIs-only group (27.1 months; P = 0.016). Additionally, the 24-month and 36-month OS rates were notably higher in the TRT+ICIs group (63.7% and 49.0%, respectively) than in the ICIs-only group (55.1% and 16.2%). Subgroup analysis of OS between the TRT+ICIs and ICIs-only groups identified factors associated with improved survival, including male sex, former smoking, Eastern Cooperative Oncology Group (ECOG) performance status 0-1, stage IIIb-c, high albumin level, and low neutrophil-to-lymphocyte (NLR) level. Multivariate analysis identified receipt of TRT, programmed death-ligand 1 (PD-L1) expression < 1%, PD-L1 ≥ 50%, and NLR as statistically significant independent prognostic factors for OS (P < 0.05). The combination treatment was well-tolerated, with an acceptable safety profile.
Our findings suggest that adding TRT to immunotherapy improves survival outcomes in patients with advanced NSCLC.
我们旨在评估在真实世界临床环境中，胸部放疗（TRT）联合免疫检查点抑制剂（ICIs）治疗晚期非小细胞肺癌（NSCLC）患者的疗效，并确定可能从这种治疗方法中获益最大的预测亚组。
我们回顾性分析了2015年1月至2022年5月在华西医院接受ICIs治疗的晚期NSCLC患者的病历。
本研究共纳入302例晚期NSCLC患者。其中，54.3%（164/302）接受ICIs联合TRT治疗，被分配至TRT+ICIs组；45.7%（138/302）仅接受ICIs治疗，被分配至单纯ICIs组。TRT+ICIs组的中位总生存期（OS）显著长于单纯ICIs组（34.7个月对27.1个月；P=0.016）。此外，TRT+ICIs组的24个月和36个月OS率明显高于单纯ICIs组（分别为63.7%和49.0%对55.1%和16.2%）。TRT+ICIs组与单纯ICIs组之间的OS亚组分析确定了与生存期改善相关的因素，包括男性、既往吸烟史、东部肿瘤协作组（ECOG）体能状态0-1、Ⅲb-c期、白蛋白水平高和中性粒细胞与淋巴细胞比值（NLR）低。多因素分析确定接受TRT、程序性死亡配体1（PD-L1）表达<1%、PD-L1≥50%和NLR为OS的统计学显著独立预后因素（P<0.05）。联合治疗耐受性良好，安全性可接受。
我们的研究结果表明，在免疫治疗中加入TRT可改善晚期NSCLC患者的生存结局。
