背景:免疫疗法(IO)为非小细胞肺癌(NSCLC)患者的一个亚组提供了显着的益处。放疗(XRT)可能会增强IO的疗效。我们评估了XRT治疗的细节对IO治疗的NSCLC患者的OS的影响。
方法:回顾性分析接受IO治疗的转移性NSCLC患者。参数包括人口统计,肿瘤特征,IO和XRT详细信息。用Cox回归测试参数与OS之间的相关性。
结果:纳入453例患者。167例(36.9%)患者未接受XRT治疗,而XRT在IO之前和之后有182例(40.2%)和104例(22.9%)患者,分别。与未接受照射的患者相比,XRT总剂量在30至40Gy之间具有更好的总生存期(OS)(风险比(HR)0.5,95%CI0.25-1.0,p=0.049)。在总剂量≤10Gy的情况下观察到更糟糕的结果(HR1.67,95%1.13-2.5,p=0.01),XRT分数为4.1-8Gy(HR1.48,95%CI1.05-2.1,p=0.027)和骨的XRT(HR1.36,95%CI1.01-1.8,p=0.04)。在IO治疗患者的单变量分析中,一些临床参数与OS相关。同时,在多变量分析中,只有ECOG-PS,治疗线,IO类型,白蛋白和NLR仍然具有统计学意义。
结论:具体剂量,在单因素分析中,XRT的分数和部位与IO治疗的NSCLC患者的OS相关,虽然不是在多变量分析中。
BACKGROUND: Immunotherapy (IO) provides a significant benefit for a subgroup of non-small cell lung cancer (NSCLC) patients. Radiotherapy (XRT) might enhance the efficacy of IO. We evaluated the impact of the specifics of XRT treatments on the OS of IO-treated NSCLC patients.
METHODS: Metastatic NSCLC patients treated with IO were retrospectively identified. Parameters included demographics, tumor characteristics, IO and XRT details. Correlation between the parameters and OS was tested with Cox regression.
RESULTS: 453 patients were included. No XRT was given to 167 (36.9%) patients, whereas XRT prior and after IO had 182 (40.2%) and 104 (22.9%) patients, respectively. XRT total doses between 30 and 40 Gy had better overall survival (OS) compared to non-irradiated patients (hazard ratio (HR) 0.5, 95% CI 0.25-1.0, p = 0.049). Worse outcome was seen with total doses ≤ 10 Gy (HR 1.67, 95% 1.13-2.5, p = 0.01), XRT fractions of 4.1-8 Gy (HR 1.48, 95% CI 1.05-2.1, p = 0.027) and XRT to the bone (HR 1.36, 95% CI 1.01-1.8, p = 0.04). Several clinical parameters correlated with OS in the univariate analysis of the IO-treated patients. While, in the multivariate analysis, only ECOG-PS, treatment line, type of IO, albumin and NLR remained statistically significant.
CONCLUSIONS: Specific doses, fractions and sites of XRT correlated with the OS of IO-treated NSCLC patients in the univariate analysis, although not in the multivariate analysis.