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Abstract：
BACKGROUND: Durvalumab consolidation after chemoradiotherapy (CRT) is a standard treatment for locally advanced non-small cell lung cancer (NSCLC). However, studies on immunological and nutritional markers to predict progression-free survival (PFS) and overall survival (OS) are inadequate. Systemic inflammation causes cancer cachexia and negatively affects immunotherapy efficacy, which also reflects survival outcomes.
METHODS: We retrospectively investigated 126 patients from seven institutes in Japan.
RESULTS: The modified Glasgow Prognostic Score (mGPS) values, before and after CRT, were the essential predictors among the evaluated indices. A systemic inflammation-based prognostic risk classification was created by combining mGPS values before CRT, and C-reactive protein (CRP) levels after CRT, to distinguish tumor-derived inflammation from CRT-induced inflammation. Patients were classified into high-risk (n = 31) and low-risk (n = 95) groups, and the high-risk group had a significantly shorter median PFS of 7.2 months and an OS of 19.6 months compared with the low-risk group. The hazard ratios for PFS and OS were 2.47 (95% confidence interval [CI]: 1.46-4.19, p < 0.001) and 3.62 (95% CI: 1.79-7.33, p < 0.001), respectively. This association was also observed in the subgroup with programmed cell death ligand 1 expression of ≥50%, but not in the <50% subgroup. Furthermore, durvalumab discontinuation was observed more frequently in the high-risk group than in the low-risk group.
CONCLUSIONS: Combining pre-CRT mGPS values with post-CRT CRP levels in patients with locally advanced NSCLC helps to predict the PFS and OS of durvalumab consolidation after CRT.
METHODS: We retrospectively investigated 126 patients from seven institutes in Japan.
RESULTS: The modified Glasgow Prognostic Score (mGPS) values, before and after CRT, were the essential predictors among the evaluated indices. A systemic inflammation-based prognostic risk classification was created by combining mGPS values before CRT, and C-reactive protein (CRP) levels after CRT, to distinguish tumor-derived inflammation from CRT-induced inflammation. Patients were classified into high-risk (n = 31) and low-risk (n = 95) groups, and the high-risk group had a significantly shorter median PFS of 7.2 months and an OS of 19.6 months compared with the low-risk group. The hazard ratios for PFS and OS were 2.47 (95% confidence interval [CI]: 1.46-4.19, p < 0.001) and 3.62 (95% CI: 1.79-7.33, p < 0.001), respectively. This association was also observed in the subgroup with programmed cell death ligand 1 expression of ≥50%, but not in the <50% subgroup. Furthermore, durvalumab discontinuation was observed more frequently in the high-risk group than in the low-risk group.
CONCLUSIONS: Combining pre-CRT mGPS values with post-CRT CRP levels in patients with locally advanced NSCLC helps to predict the PFS and OS of durvalumab consolidation after CRT.
摘要：
背景：放化疗（CRT）后Durvalumab巩固是局部晚期非小细胞肺癌（NSCLC）的标准治疗方法。然而,预测无进展生存期(PFS)和总生存期(OS)的免疫学和营养标志物研究不足.全身性炎症会导致癌症恶病质，并对免疫治疗效果产生负面影响。这也反映了生存结果。
方法：我们回顾性调查了来自日本7个研究所的126例患者。
结果：修改后的格拉斯哥预后评分（mGPS）值，在CRT之前和之后，是评价指标中的基本预测因子。通过结合CRT之前的mGPS值来创建基于全身炎症的预后风险分类，CRT后C反应蛋白（CRP）水平，区分肿瘤源性炎症和CRT诱导的炎症。患者分为高风险组（n=31）和低风险组（n=95）。与低危组相比,高危组的中位PFS为7.2个月,OS为19.6个月.PFS和OS的风险比为2.47（95％置信区间[CI]：1.46-4.19，p<0.001）和3.62（95％CI：1.79-7.33，p<0.001），分别。在程序性细胞死亡配体1表达≥50％的亚组中也观察到这种关联。但在<50%亚组中没有。此外，高危组的durvalumab停药频率高于低危组.
结论：结合局部晚期NSCLC患者CRT前mGPS值和CRT后CRP水平，有助于预测CRT后durvalumab巩固的PFS和OS。
方法：我们回顾性调查了来自日本7个研究所的126例患者。
结果：修改后的格拉斯哥预后评分（mGPS）值，在CRT之前和之后，是评价指标中的基本预测因子。通过结合CRT之前的mGPS值来创建基于全身炎症的预后风险分类，CRT后C反应蛋白（CRP）水平，区分肿瘤源性炎症和CRT诱导的炎症。患者分为高风险组（n=31）和低风险组（n=95）。与低危组相比,高危组的中位PFS为7.2个月,OS为19.6个月.PFS和OS的风险比为2.47（95％置信区间[CI]：1.46-4.19，p<0.001）和3.62（95％CI：1.79-7.33，p<0.001），分别。在程序性细胞死亡配体1表达≥50％的亚组中也观察到这种关联。但在<50%亚组中没有。此外，高危组的durvalumab停药频率高于低危组.
结论：结合局部晚期NSCLC患者CRT前mGPS值和CRT后CRP水平，有助于预测CRT后durvalumab巩固的PFS和OS。
