| 胥泽玺,翁一鸣,金 瑶.免疫检查点抑制剂联合治疗96例晚期非小细胞肺癌的疗效分析[J].肿瘤学杂志,2022,28(1):28-34. |
| 免疫检查点抑制剂联合治疗96例晚期非小细胞肺癌的疗效分析 |
| Efficacy Analysis of Treatment with Combined Immune Checkpoint Inhibitor in 96 Cases with Advanced Non-small Cell Lung Cancer |
| 投稿时间：2021-09-12 |
| DOI：10.11735/j.issn.1671-170X.2022.01.B006 |
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| 中文关键词: 免疫疗法 联合化疗 血管生成抑制剂 癌，非小细胞肺 预测 |
| 英文关键词:immunotherapy combined chemotherapy angiogenic inhibitors cancer, non-small cell lung prediction |
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| 中文摘要: |
| 摘 要：［目的］ 探讨免疫检查点抑制剂（immune checkpoint inhibitor，ICI）联合化疗及抗血管生成药物在晚期非小细胞肺癌（non-small cell lung cancer，NSCLC）患者治疗中的有效性及预后预测因子。［方法］ 回顾性分析96例晚期NSCLC患者的临床资料，计算其无进展生存期（progression-free survival，PFS）、客观缓解率（objective response rate，ORR）及不良事件，分析与PFS相关的预后预测因子。［结果］ 一线接受ICI联合治疗患者的PFS优于二线及后线患者（中位PFS：7.10 个月vs 5.10个月，P=0.036）。一线联合治疗的56例患者中，ICI联合化疗加抗血管生成药物组PFS优于无抗血管生成药物组（中位PFS：8.57 个月vs 7.00个月，P=0.031）。Cox多因素回归分析结果显示，联合抗血管生成药物（P=0.045）、营养预后指数(PNI)>44.55（P=0.034）为PFS的独立预后因素。二线及后线联合治疗的40例患者中，联合抗血管生成药物组与无抗血管生成药物组PFS差异无统计学意义（中位PFS：5.53 个月vs 4.73个月，P=0.092）。年龄≥57岁（P<0.001）、中性粒细胞淋巴细胞比值(NLR)≤4.50（P=0.003）为PFS的独立预后因素。有无联合抗血管生成药物组之间的3级以上不良事件发生率相当。 ［结论］一线行ICI联合治疗或能使PFS获益更佳，特别是ICI联合化疗及抗血管生成药物的治疗策略。高PNI和低NLR及年龄或许能帮助筛选出不同治疗线中潜在获益更佳的人群。 |
| 英文摘要: |
| Abstract： ［Objective］ To explore the efficacy and prognostic predictors of immune checkpoint inhibitor(ICI) combined with chemotherapy and anti-angiogenic drugs in the treatment of patients with advanced non-small cell lung cancer(NSCLC). ［Methods］ Clinical data of 96 eligible patients with advanced NSCLC were analyzed retrospectively. The progression-free survival(PFS)， objective response rate(ORR) and adverse event(AE) were caculated， and the prognostic predictors associated with PFS was analyzed. ［Results］ Patients treated with combined ICI had better PFS with first-line therapy than those with second-line or later therapy(median PFS：7.10 months vs 5.10 months， P=0.036). In 56 patients treated with the first-line therapy， PFS of ICI combined with chemotherapy plus anti-angiogenic group outperformed non-combined anti-angiogenesis therapy group(median PFS：8.57 months vs 7.00 months， P=0.031). The results of the Cox multivariate regression analysis revealed that， antiangiogenic agents(P=0.045) and PNI levels >44.55(P=0.034) were independent favorable prognostic factors for PFS. In 40 patients treated with the second-line or later therapy， the PFS difference was not statistically significant between the combined anti-angiogenic group and the non-combined antiangiogenic group(median PFS：5.53 months vs 4.73 months， P=0.092)， and the results of Cox multivariate regression analysis showed that age≥57 years old(P<0.001) and NLR level ≤4.50(P=0.003) were independent favorable prognostic factors for PFS. The incidence of grade 3 AE of whether or without using combined antiangiogenic drugs was comparable in all study subjects. ［Conclusion］ Patients receiving first-line treatment with combined ICI have better PFS results， especially when ICI combined with chemotherapy and anti-antiangiogenic drugs. High PNI levels， low NLR levels and age may help us to screen populations that potentially benefit better from different treatment lines. |
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