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| 免疫时代Ⅲ期不可切NSCLC初治放疗对比化疗疗效差异 及SEER数据库验证研究 |
| Efficacy Differences of Initial Radiotherapy Versus Chemotherapy of stage III unresectable NSCLC in the Immunotherapy Era: A comparative study and SEER Database Validation Study |
| 投稿时间：2025-11-17 修订日期：2026-05-10 |
| DOI： |
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| 中文关键词: 非小细胞肺癌 放射治疗 化学药物治疗 免疫治疗 总生存 |
| 英文关键词:non‐small cell lung Radiotherapy Chemotherapy Immunotherapy overall survival |
| 基金项目:浙江省公益基础项目(LGF21H160027)；浙江省医药卫生科技计划项目(2024KY1829)；台州市抗癌协会专项课题(TACA2025-C01) |
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| 中文摘要: |
| 【摘要】 目的 探讨免疫治疗前初始治疗为放疗或化疗对III期不可切除非小细胞肺癌(non-small cell lung cancer, NSCLC)患者生存预后的影响。方法 纳入2018年1月至2024年10月于本中心治疗的157例初诊为III期不可切除的NSCLC患者，根据免疫治疗前的初治模式分为放疗组（40例）和化疗组（114例）；并收集2018.01-2021.01SEER数据库中初诊为III期不可切除NSCLC患者（N=6610例），通过倾向评分匹配法(propensityscore matching，PSM) 与本中心入组患者1:2匹配，最终纳入308例患者，其中放疗组120例、化疗组342例。采用Kaplan-Meier曲线分析总生存（overall survival, OS）和无进展生存（progression-free survival，PFS）。采用Cox回归分析影响OS的风险预后因素。结果 本中心队列中初治放疗组和化疗组患者的mPFS和mOS比较分别为18.0m vs 16.0m（P=0.02）,和 72.0m vs 28.0m（P=0.039）。SEER队列中，初治放疗组和化疗组的mOS分别为33.0月和20.0月（P=0.047）。单、多因素COX回归分析显示免疫治疗前初治接受的治疗模式是OS的独立预后因素，初始接受放疗相较于初始接受化疗死亡风险下降35%（HR= 0.655，95% CI：0.466~0.920，P =0.015）。结论 免疫时代，初始接受放疗的不可切除III期NSCLC患者的生存获益高于初始接受化疗的患者。 |
| 英文摘要: |
| 【Abstract】Objective：This study examines the impact of initial radiotherapy versus chemotherapy before immunotherapy on survival outcomes in patients with stage III unresectable non-small cell lung cancer (NSCLC).Methods：Include 157 patients with newly diagnosed stage III unresectable NSCLC treated at our center from January 2018 to October 2024. Based on the initial treatment modality prior to immunotherapy, patients were divided into a radiotherapy group (40 cases) and a chemotherapy group (114 cases). Additionally, 6,610 patients with newly diagnosed stage III unresectable NSCLC from the SEER database (January 2018 to January 2021) were identified. These were matched 1:2 to our center""s enrolled patients using propensity score matching (PSM), resulting in 308 matched patients: 120 in the radiotherapy group and 342 in the chemotherapy group. Kaplan-Meier curves were used to analyze overall survival (OS) and progression-free survival (PFS). Cox regression analysis was employed to identify risk factors affecting OS.Results：The median progression-free survival (mPFS) and median overall survival (mOS) in the radiotherapy and chemotherapy groups of our cohort were 18.0 months vs 16.0 months (P=0.02) and 72.0 months vs 28.0 months (P=0.039), respectively. In the SEER cohort, mOS for the initial radiotherapy group and chemotherapy group was 33.0 months and 20.0 months, respectively (P=0.047). Univariate and multivariate Cox regression analyses demonstrated that the treatment modality received prior to immunotherapy was an independent prognostic factor for OS. Initial radiotherapy was associated with a 35% reduction in the risk of death compared to initial chemotherapy (HR = 0.655, 95% CI: 0.466–0.920, P = 0.015).Conclusions：In the era of immunotherapy, patients with unresectable stage III NSCLC who initially receive radiotherapy demonstrate superior survival outcomes compared to those who initially receive chemotherapy. |
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