Abstract：
OBJECTIVE: This study aimed to evaluate the efficacy of local ablative therapy (LAT) combined with pembrolizumab in patients with synchronous oligometastatic non-small cell lung cancer (NSCLC) and to identify patients who would most benefit from LAT.
METHODS: We retrospectively identified patients who received diagnosis of synchronous oligometastatic NSCLC (≤5 metastatic lesions and ≤3 organs involved) and were treated with first-line pembrolizumab between January 2017 and December 2022. Patients who underwent LAT, including surgery or radiation therapy at all disease sites, were compared with those who did not undergo LAT. A recursive partitioning analysis (RPA) model was developed using prognostic factors for progression-free survival (PFS).
RESULTS: Among the 258 patients included, 78 received LAT with pembrolizumab, and 180 received pembrolizumab alone. The median follow-up duration was 15.5 months (range, 3.0-71.2 months). In the entire cohort, LAT was independently associated with significantly improved PFS (hazard ratio [HR], 0.64; P = .015) and overall survival (OS) (HR, 0.61; P = .020). In the propensity score-matched cohort (N = 74 in each group), the median PFS was 19.9 months and 9.6 months, respectively (P = .003), and the median OS was 42.2 months and 20.5 months, respectively (P = .045), for the LAT and non-LAT groups. Based on the RPA model, incorporating the number of metastatic lesions, performance status, and programmed cell death-ligand 1 expression level, patients were stratified into 3 risk groups with distinct PFS. LAT significantly improved PFS and OS in the low- and intermediate-risk groups; however, no difference was observed in the high-risk group. LAT was more effective as a consolidative treatment after pembrolizumab initiation than as an upfront therapy.
CONCLUSIONS: LAT combined with pembrolizumab was associated with higher PFS and OS compared with pembrolizumab alone in selected patients with synchronous oligometastatic NSCLC. The RPA model could serve as a valuable clinical tool for identifying appropriate patients for LAT.
METHODS: We retrospectively identified patients who received diagnosis of synchronous oligometastatic NSCLC (≤5 metastatic lesions and ≤3 organs involved) and were treated with first-line pembrolizumab between January 2017 and December 2022. Patients who underwent LAT, including surgery or radiation therapy at all disease sites, were compared with those who did not undergo LAT. A recursive partitioning analysis (RPA) model was developed using prognostic factors for progression-free survival (PFS).
RESULTS: Among the 258 patients included, 78 received LAT with pembrolizumab, and 180 received pembrolizumab alone. The median follow-up duration was 15.5 months (range, 3.0-71.2 months). In the entire cohort, LAT was independently associated with significantly improved PFS (hazard ratio [HR], 0.64; P = .015) and overall survival (OS) (HR, 0.61; P = .020). In the propensity score-matched cohort (N = 74 in each group), the median PFS was 19.9 months and 9.6 months, respectively (P = .003), and the median OS was 42.2 months and 20.5 months, respectively (P = .045), for the LAT and non-LAT groups. Based on the RPA model, incorporating the number of metastatic lesions, performance status, and programmed cell death-ligand 1 expression level, patients were stratified into 3 risk groups with distinct PFS. LAT significantly improved PFS and OS in the low- and intermediate-risk groups; however, no difference was observed in the high-risk group. LAT was more effective as a consolidative treatment after pembrolizumab initiation than as an upfront therapy.
CONCLUSIONS: LAT combined with pembrolizumab was associated with higher PFS and OS compared with pembrolizumab alone in selected patients with synchronous oligometastatic NSCLC. The RPA model could serve as a valuable clinical tool for identifying appropriate patients for LAT.
摘要：
目的：本研究旨在评估局部消融治疗（LAT）联合派姆单抗对同步寡转移非小细胞肺癌（NSCLC）患者的疗效，并确定最受益于LAT的患者。
方法：我们回顾性确定了2017年1月至2022年12月期间诊断为同步寡转移NSCLC（≤5个转移灶和≤3个器官受累）并接受一线派姆单抗治疗的患者。接受LAT的患者，包括所有疾病部位的手术或放疗，与没有接受LAT的人进行比较。使用无进展生存期（PFS）的预后因素开发了递归分区分析（RPA）模型。
结果：在258名患者中，78人接受了LAT和派博利珠单抗，180人单独接受了派博利珠单抗。中位随访时间为15.5个月(范围，3.0-71.2)。在整个队列中，LAT与显著改善的PFS独立相关(风险比[HR]，0.64；P=0.015）和总生存期（OS）（HR，0.61；P=0.020）。在倾向得分匹配的队列中(每组N=74)，中位PFS为19.9个月和9.6个月，分别为(P=0.003)，中位OS分别为42.2个月和20.5个月，分别为(P=0.045)，对于LAT和非LAT组。基于RPA模型,结合转移性病变的数量，性能状态，和PD-L1表达水平，患者被分层为具有不同PFS的三个风险组.LAT显著改善了低风险和中风险组的PFS和OS；然而，在高危组中没有观察到差异.LAT作为pembrolizumab开始后的巩固治疗比作为前期治疗更有效。
结论：在选定的同步寡转移NSCLC患者中，与单独使用派姆单抗相比，LAT联合派姆单抗与更高的PFS和OS相关。RPA模型可以作为鉴定LAT的合适患者的有价值的临床工具。
方法：我们回顾性确定了2017年1月至2022年12月期间诊断为同步寡转移NSCLC（≤5个转移灶和≤3个器官受累）并接受一线派姆单抗治疗的患者。接受LAT的患者，包括所有疾病部位的手术或放疗，与没有接受LAT的人进行比较。使用无进展生存期（PFS）的预后因素开发了递归分区分析（RPA）模型。
结果：在258名患者中，78人接受了LAT和派博利珠单抗，180人单独接受了派博利珠单抗。中位随访时间为15.5个月(范围，3.0-71.2)。在整个队列中，LAT与显著改善的PFS独立相关(风险比[HR]，0.64；P=0.015）和总生存期（OS）（HR，0.61；P=0.020）。在倾向得分匹配的队列中(每组N=74)，中位PFS为19.9个月和9.6个月，分别为(P=0.003)，中位OS分别为42.2个月和20.5个月，分别为(P=0.045)，对于LAT和非LAT组。基于RPA模型,结合转移性病变的数量，性能状态，和PD-L1表达水平，患者被分层为具有不同PFS的三个风险组.LAT显著改善了低风险和中风险组的PFS和OS；然而，在高危组中没有观察到差异.LAT作为pembrolizumab开始后的巩固治疗比作为前期治疗更有效。
结论：在选定的同步寡转移NSCLC患者中，与单独使用派姆单抗相比，LAT联合派姆单抗与更高的PFS和OS相关。RPA模型可以作为鉴定LAT的合适患者的有价值的临床工具。
