摘要
目的:评价老年晚期非小细胞肺癌(non-smallcelllungcancer,NSCLC)患者接受免疫检查点抑制剂治疗的疗效和安全性,探索疗效和预后相关生物标志物。方法:回顾性收集2018年3月至2021年10月于中国3家医院接受免疫治疗的老年晚期NSCLC患者资料,对免疫治疗的疗效和安全性进行评估,应用Kaplan-Meier法和Log-rank检验进行生存分析,并采用单因素及多因素Cox风险比例回归模型、t-test来检验各项临床特征和实验室指标与生存的相关性。结果:研究共纳入102例患者,客观缓解率为41.02%,疾病控制率为88.46%,中位无进展生存时间(pro-gression-freesurvival,PFS)为7.5个月,中位总生存时间(overallsurvival,OS)为22.0个月。单因素分析显示,ECOG PS评分0~1分(P=0.041)、无肝转移(P=0.048)和一线治疗(P=0.047)与更长的PFS显著相关,吸烟史(P=0.010)、无脑转移(P<0.001)与更长的OS显著相关。多因素分析显示,ECOGPS评分≥2分患者的PFS(P=0.001)和OS(P<0.001)明显短于0~1分者,联合治疗组的PFS明显长于单药治疗组(P=0.031),脑转移患者的OS明显短于不伴脑转移者(P=0.017)。48例(47.06%)患者在接受免疫治疗时出现不良事件,其中21例(20.59%)患者出现≥3级不良事件。预后不佳组患者的基线期血红蛋白(P=0.026)、白蛋白(P=0.025)水平较预后良好组显著降低。结论:老年晚期NSCLC患者接受免疫检查点抑制剂治疗的疗效和安全性良好,ECOGPS评分0~1分、有吸烟史、一线及联合治疗的患者可能是免疫治疗的潜在优势人群,基线期白蛋白、血红蛋白水平降低可能预示着免疫治疗效果不佳。
Objective: To evaluate the efficacy and safety of immune checkpoint inhibitors in elderly patients with advanced non-small cell lung cancer, and explore the biomarkers related to efficacy and prognosis. Methods: In this retrospective study, we collected data of elderly patients with advanced lung cancer who received immunotherapy in three hospitals in China from March 2018 to October 2021, and evaluated the efficacy and safety of immunotherapy. Kaplan-Meier method and Log-rank test were used for survival analysis. Univariate and multivariate Cox proportional hazard regression models and t-test were used to testify the correlation of survival to clinical characteristics and laboratory results. Results: A total of 102 patients were included in the study, with an ORR of 41.02%, DCR of 88.46%, median PFS of 7.5 months, and median OS of 22.0 months. Univariate analysis showed that ECOG PS score of 0-1(P=0.041), liver metastasis(P=0.048) and first-line treatment(P=0.047) were significantly correlated to longer progression-free survival(PFS);and smoking history(P=0.010) and brain metastasis(P<0.001) were significantly correlated to longer overall survival(OS). Multivariate analysis showed that PFS(P=0. 001) and OS(P<0. 001) in patients with ECOG PS score of ≥ 2 were significantly shorter than those in patients with ECOG PS score of 0-1. PFS in the combined treatment group was significantly longer than that in the single treatment group(P=0.031). OS in patients with brain metastasis was significantly shorter than those without brain metastasis(P=0.017). 48 patients(47.06%) had adverse events during immunotherapy, of which 21 patients(20.59%) had grade ≥3 adverse events. The baseline hemoglobin(P=0.026) and albumin(P=0.025) levels in the poor prognosis group were significantly lower than those in the good prognosis group. Conclusion: This study suggests that immune checkpoint inhibitors are efficient and well tolerated in elderly patients with advanced non-small cell lung cancer. Patients with ECOG PS score of 0-1, sm
作者
陈靖宇
张欢
夏杨晨
刘芳芳
蒋继宗
朱正飞
胡洁
褚倩
Chen Jingyu;Zhang Huan;Xia Yangcheng;Liu Fangfang;Jiang Jizong;Zhu Zhengfei;Hu Jie;Chu Qian(Department of Oncology,Tongji Hospital of Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,Hubei,China;Second Clinical College,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,Hubei,China;Department of Radiation Oncology,Fudan University Shanghai Cancer Center,Shanghai 200032 China;Department of PulmonaryMedicine,Zhongshan Hospital,Fudan Universily,Shanghai 200032,China)
出处
《肿瘤预防与治疗》
2022年第9期800-811,共12页
Journal of Cancer Control And Treatment
基金
希思科-信达肿瘤免疫治疗研究基金(编号:Y-XD2019-214)。
关键词
非小细胞肺癌
老年患者
免疫治疗
疗效
安全性
Non-small cell lung cancer
Elder patients
Immunotherapy
Efficacy
Safety
