| 杜喆,赵雨婷,石安辉,等.免疫检查点抑制剂联合胸部放疗对同时性寡转移非小细胞肺癌患者生存的影响[J].中华放射医学与防护杂志,2025,45(7):637-646.Du Zhe,Zhao Yuting,Shi Anhui,et al.Impact of immune checkpoint inhibitors combined with thoracic radiotherapy on the survival of patients with synchronous oligometastatic non-small cell lung cancer[J].Chin J Radiol Med Prot,2025,45(7):637-646 |
| 免疫检查点抑制剂联合胸部放疗对同时性寡转移非小细胞肺癌患者生存的影响 |
| Impact of immune checkpoint inhibitors combined with thoracic radiotherapy on the survival of patients with synchronous oligometastatic non-small cell lung cancer |
| 投稿时间：2025-03-03 |
| DOI：10.3760/cma.j.cn112271-20250303-00070 |
| 中文关键词: 非小细胞肺癌 同时性寡转移 免疫检查点抑制剂 胸部放疗 生存预后 |
| 英文关键词:Non-small cell lung cancer (NSCLC) Synchronous oligometastasis Immune checkpoint inhibitor (ICI) Thoracic radiotherapy Survival outcome |
| 基金项目:北京市医院管理中心临床医学发展专项经费(ZLRK202327) |
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| 中文摘要: |
| 目的 探究胸部放疗对一线接受免疫检查点抑制剂(ICI)治疗的同时性寡转移驱动基因阴性非小细胞肺癌(NSCLC)患者的预后价值和安全性。方法 回顾性收集了2017年1月至2022年3月期间接受一线免疫检查点抑制剂和放疗的55例同时性寡转移驱动基因阴性NSCLC患者的数据。根据是否接受胸部放疗将患者分为胸部放疗组(n=27)和非胸部放疗组(n=28),比较两组患者的生存预后和安全性。结果 55例患者中共有27例(49.1%)联合胸部放疗。全组中位随访时间为37.0个月(2.2~76.7个月)。胸部放疗组的中位总生存(53.4 vs.20.7个月,χ2=6.02,P=0.014)和中位无进展生存(13.6 vs.8.3个月,χ2=4.11,P=0.043)均优于非胸部放疗组。多因素Cox回归显示,胸部放疗是总生存(HR=0.39,95%CI:0.17~0.90,P=0.027)和无进展生存(HR=0.53,95%CI:0.28~0.99,P=0.046)的独立预后因素。最常见的3级及以上不良反应为骨髓抑制(7/55,12.7%)。两组患者在包括治疗相关性肺炎在内的3级或以上不良反应的发生率差异均无统计学意义(P>0.05)。结论 对于同时性寡转移驱动基因阴性的NSCLC患者,一线免疫治疗中加入胸部放疗可能改善生存,且未增加严重治疗相关不良反应,后续需要开展大规模随机前瞻性试验进一步探究。 |
| 英文摘要: |
| Objective To investigate the prognostic value and safety of thoracic radiotherapy in patients with synchronous oligometastatic, driver gene-negative non-small cell lung cancer (NSCLC) receiving immune checkpoint inhibitors (ICIs) as first-line treatment. Methods Data were retrospectively collected from 55 patients diagnosed with synchronous oligometastatic, driver gene-negative NSCLC who received first-line ICIs from January 2017 to March 2022. These patients were categorized into two groups based on the administration of thoracic radiotherapy: the thoracic radiotherapy group (n = 27) and the non-thoracic radiotherapy group (n = 28). Comparative analyses were conducted to evaluate survival outcomes and safety profiles between the two groups. Results Among the 55 patients, 27 (49.1%) received thoracic radiotherapy. The median follow-up time was 37.0 months (2.2-76.7 months). Patients in the thoracic radiotherapy group exhibited significantly improved median overall survival (OS: 53.4 vs. 21.3 months, P = 0.049) and median progression-free survival (PFS: 13.6 vs. 8.3 months, χ2=4.11,P = 0.043) compared to those in the non-thoracic radiotherapy group. Multivariate Cox regression analysis identified thoracic radiotherapy as an independent prognostic factor for OS (HR = 0.39, 95% CI: 0.17-0.90, P = 0.027) and PFS (HR = 0.53, 95% CI: 0.28-0.99, P = 0.046). The most common grade 3 or higher toxicity was bone marrow suppression, occurring in seven patients (12.7%). There was no significant difference between both groups in the incidence of grade 3 or higher treatment-related adverse events, including pneumonitis.Conclusion In patients with driver gene-negative, synchronous oligometastatic NSCLC, first-line immunotherapy combined with thoracic radiotherapy may improve survival outcomes without increasing the incidence of severe treatment-related adverse events. Further large-scale, randomized prospective trials are needed to verify the findings of this study. |
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