| 张耀文,温晶媛,汪晨宇,等.放疗在免疫联合化疗一线治疗非小细胞肺癌寡转移患者中的应用价值[J].中华放射医学与防护杂志,2025,45(2):91-100.Zhang Yaowen,Wen Jingyuan,Wang Chenyu,et al.The role of radiotherapy in combined immunotherapy and chemotherapy as first-line treatment for oligometastatic non-small cell lung cancer[J].Chin J Radiol Med Prot,2025,45(2):91-100 |
| 放疗在免疫联合化疗一线治疗非小细胞肺癌寡转移患者中的应用价值 |
| The role of radiotherapy in combined immunotherapy and chemotherapy as first-line treatment for oligometastatic non-small cell lung cancer |
| 投稿时间：2024-09-02 |
| DOI：10.3760/cma.j.cn112271-20240902-00332 |
| 中文关键词: 非小细胞肺癌 寡转移 放射治疗 免疫联合化疗 一线治疗 预后 |
| 英文关键词:Cancer Non-small cell lung cancer Oligometastasis Radiotherapy Immunochemotherapy First-line treatment Prognosis |
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| 中文摘要: |
| 目的 探讨放疗在免疫联合化疗一线治疗非小细胞肺癌(NSCLC)寡转移患者中的应用价值。方法 回顾性分析2019年1月至2021年12月河南省安阳市肿瘤医院和河北医科大学第四医院收治的195例无表皮生长因子受体(EGFR)或间变性淋巴瘤激酶基因异常的NSCLC患者资料, 其中男166例, 女29例;年龄28~85(61.4±9.3)岁。根据患者是否接受放疗将患者分为放疗联合免疫和化疗组(60例)以及免疫联合化疗组(135例), 进行倾向性评分匹配(PSM), 分析PSM前后两组患者的预后差异以及PSM后两组患者的近期疗效和不良反应。结果 全组195例患者的中位随访时间为31.8个月, 中位生存时间(OS)和中位无进展生存时间(PFS)分别为23.8和9.2个月。放疗联合免疫和化疗组患者的1、2、3年生存率分别为78.5%、55.9%和45.1%, 明显高于免疫联合化疗组的48.3%、35.6%和26.6%(χ2 = 14.65, P＜0.001)。放疗联合免疫和化疗组患者的1、2、3年无进展生存率分别为51.9%、29.5%和22.7%, 明显高于免疫联合化疗组的30.0%、24.5%和16.9%, 差异有统计学意义(χ2 = 6.09, P = 0.014)。PSM后, 55例放疗联合免疫和化疗组患者的客观缓解率(ORR)为60.0%(33/55), 疾病控制率(DCR)为89.1%(49/55);55例免疫联合化疗组患者的ORR为16.4%(9/55), DCR为56.4%(31/55);放疗联合免疫和化疗组患者的ORR和DCR均明显优于免疫联合化疗组(χ2 = 22.18、14.85, P＜0.001)。放疗联合免疫和化疗组患者的1、2、3年生存率分别为70.9%、52.3%和41.9%, 明显高于免疫联合化疗组的43.6%、29.8%和27.1%, 差异有统计学意义(χ2 = 8.95, P = 0.003)。放疗联合免疫和化疗组患者的1、2、3年无进展生存率分别为47.3%、27.3%和18.7%, 明显高于免疫联合化疗组的23.6%、17.6%和15.4%, 差异有统计学意义(χ2 = 6.71, P = 0.010)。Cox多因素分析显示, 临床分期、治疗模式、免疫治疗周期数和治疗疗效为影响患者OS的独立因素(HR = 1.88、2.11、0.23、1.79, P < 0.05);治疗模式、免疫治疗周期数和治疗疗效为影响患者PFS的独立因素(HR = 1.62、0.37、3.42, P < 0.05)。放疗联合免疫和化疗组与免疫联合化疗组≥2级以上骨髓抑制的发生率(分别为18.2%和12.7%)和≥2级肺炎的发生率(分别为21.8%和14.5%)差异均无统计学意义(P>0.05)。结论 放疗在接受免疫联合化疗一线治疗NSCLC寡转移患者中, 可优化局部和全身疾病控制, 显著改善患者的预后, 且不增加治疗相关不良反应。 |
| 英文摘要: |
| Objective To evaluate the therapeutic value of radiotherapy in combined immunotherapy and chemotherapy as first-line treatment for patients with oligometastatic non-small cell lung cancer (NSCLC). Methods A retrospective analysis was conducted on data from 195 NSCLC patients who lacked epidermal growth factor receptor (EGFR) or anaplastic lymphoma kinase (ALK) mutations and were treated at the Anyang Tumor Hospital and the Fourth Hospital of Hebei Medical University from January 2019 to December 2021. These patients consisted of 166 male and 29 female cases, aged from 28 to 85 years, with an average age of (61.4 ±9.3) years. These patients were divided into two groups, with each group receiving the radiotherapy and combined immunotherapy and chemotherapy (the radiotherapy and combination group, n = 60) and combined immunotherapy and chemotherapy only (the combination group, n = 135). Then, propensity score matching (PSM) was performed to analyze the differences in prognosis between both groups before and after PSM, as well as the short-term efficacy and adverse reactions after PSM. Results For the 195 NSCLC patients, the median follow-up time was 31.8 months, with median overall survival (OS) and median progression-free survival (PFS) recorded at 23.8 months and 9.2 months, respectively. The radiotherapy and combination group exhibited enhanced 1-, 2-, and 3-year survival rates of 78.5%, 55.9%, and 45.1%, respectively, significantly higher than the combination group (48.3%, 35.6%, and 26.6%, respectively, χ2 = 14.65, P < 0.001). Similarly, the radiotherapy and combination group displayed 1-, 2-, and 3-year PFS rates of 51.9%, 29.5%, and 22.7%, respectively, exceeding those of the combination group (30.0%, 24.5%, and 16.9%, respectively, χ2 = 6.09, P = 0.014). After PSM, the radiotherapy and combination group manifested an objective response rate (ORR) of 60.0% (33/55) and a disease control rate (DCR) of 89.1% (49/55), which were 16.4% (9/55) and 56.4% (31/55), respectively for the combination group. These results suggested that the radiotherapy and combination group demonstrated significantly higher ORR and DCR (χ2 = 22.18, 14.85, P < 0.001). After PSM, the radiotherapy and combination group yielded 1-, 2-, and 3-year survival rates of 70.9%, 52.3%, and 41.9%, respectively, significantly than the combination group (43.6%, 29.8%, and 27.1%, respectively, χ2 = 8.95, P = 0.003). The radiotherapy and combination group exhibited 1-, 2-, and 3-year PFS rates of 47.3%, 27.3%, and 18.7%, respectively, significantly higher than the combination group (23.6%, 17.6%, and 15.4%, respectively, χ2 = 6.71, P = 0.010). Multivariate Cox regression analysis revealed that independent factors affecting OS included clinical stage, treatment regimen, number of immunotherapy cycles, and treatment efficacy (HR = 1.88, 2.11, 0.23, 1.79, P < 0.05). Similarly, independent factors affecting PFS consisted of treatment regimen, number of immunotherapy cycles, and treatment efficacy (HR = 1.62, 0.37, 3.42, P <0.05). There were no statistical differences in the incidence of grade ≥ 2 bone marrow suppression (18.2% vs. 12.7%) and grade ≥ 2 pneumonia (21.8% vs. 14.5%) between both groups (P > 0.05). Conclusions Introducing radiotherapy into combined immunotherapy and chemotherapy as first-line treatment for oligometastatic NSCLC can optimize both local and systemic disease control and significantly improve patient prognosis without increasing treatment-related adverse reactions. |
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