| 韩四辈,关嵩,李娜,等.免疫治疗时代免疫细胞估计辐射剂量对Ⅲ期非小细胞肺癌放疗预后的影响[J].中华放射医学与防护杂志,2026,46(1):50-56.Han Sibei,Guan Song,Li Na,et al.Impact of the estimated radiation dose to immune cells on the prognosis of stage Ⅲ non-small cell lung cancer in the era of immunotherapy[J].Chin J Radiol Med Prot,2026,46(1):50-56 |
| 免疫治疗时代免疫细胞估计辐射剂量对Ⅲ期非小细胞肺癌放疗预后的影响 |
| Impact of the estimated radiation dose to immune cells on the prognosis of stage Ⅲ non-small cell lung cancer in the era of immunotherapy |
| 投稿时间：2024-12-24 |
| DOI：10.3760/cma.j.cn112271-20241224-00492 |
| 中文关键词: 免疫治疗 放射治疗 化学治疗 非小细胞肺癌 |
| 英文关键词:Immunotherapy Radiotherapy Chemotherapy Non-small cell lung cancer |
| 基金项目:天津市医学重点学科(专科)建设项目(TJYXZDXK-009A) |
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| 中文摘要: |
| 目的 探讨免疫细胞估计辐射剂量(EDRIC)在免疫治疗时代对Ⅲ期非小细胞肺癌预后的影响。方法 回顾性分析2018年1月至2023年6月在天津医科大学肿瘤医院接受放化疗联合免疫治疗的192例Ⅲ期非小细胞肺癌患者的临床资料。利用EDRIC公式计算循环血液免疫细胞所受辐射剂量。采用Kaplan-Meier法对总生存期(OS)、局部无进展生存期(LPFS)和远处无转移生存期(DMFS)进行生存分析。单因素和多因素Cox比例风险回归模型分析潜在预后因素与生存指标的关系。结果 全组患者中位OS 36.0个月、中位LPFS 22.0个月、中位DMFS 25.0个月。中位EDRIC 6.4 Gy。EDRIC < 6.4 Gy的患者比EDRIC ≥ 6.4 Gy患者中位OS(χ2=7.92,P=0.005)、中位DMFS(χ2=4.56,P=0.033)明显延长。Cox多因素分析显示,EDRIC是影响OS、DMFS的独立预后因素。以临床分期分层分析,ⅢA期患者EDRIC < 6.4 Gy组相比EDRIC ≥ 6.4 Gy组中位OS(χ2=5.46,P=0.020)、中位DMFS(χ2=6.21,P=0.013)显著延长。ⅢB期患者EDRIC < 6.4 Gy组与EDRIC ≥ 6.4 Gy组的中位OS(P=0.240)、中位LPFS (P=0.685)、中位DMFS(P=0.639)未见明显差异。但ⅢC期患者EDRIC < 6.4 Gy组相比EDRIC ≥ 6.4 Gy组中位LPFS (χ2=10.36,P=0.001)显著缩短,而中位OS(P=0.383)、中位DMFS(P=0.975)未见明显差异。结论 EDRIC是影响放化疗联合免疫治疗的Ⅲ期非小细胞肺癌预后的独立危险因素,更高的EDRIC预示着更差的预后,尤其是在肿瘤负荷相对较少的ⅢA期患者。 |
| 英文摘要: |
| Objective To explore the impact of the estimated dose of radiation to immune cells (EDRIC) on the prognosis of stage Ⅲ non-small cell lung cancer (NSCLC) patients who received immunotherapy and chemoradiotherapy in the era of immunotherapy. Methods A retrospective analysis was performed on the clinical data of 192 patients with stage Ⅲ NSCLC who underwent immunotherapy and chemoradiotherapy at the Cancer Hospital of Tianjin Medical University from January 2018 to June 2023. The radiation dose received by circulating blood immune cells was calculated using the EDRIC formula. The Kaplan-Meier method was used to analyze the overall survival (OS), local progression-free survival (LPFS), and distant metastasis-free survival (DMFS). The relationship between potential prognostic factors and survival indicators was analyzed using univariate and multivariate Cox proportional hazards regression models. Results The median OS, LPFS and DMFS of the whole cohert were 36.0 months, 22.0 months and 25.0 months, respectively, with a median EDRIC of 6.4 Gy. Patients with EDRIC <6.4 Gy had significantly longer median OS (χ2 = 7.92,P = 0.005) and median DMFS (χ2 = 4.56,P = 0.033) than those with EDRIC ≥ 6.4 Gy. Multivariate Cox regression analysis confirmed that EDRIC was significantly correlated with OS and DMFS. Stratified by clinical stage: in stage ⅢA patients, median OS (χ2 = 5.46,P = 0.020) and median DMFS (χ2 = 6.21,P = 0.013) were significantly longer in the EDRIC < 6.4 Gy group than in the EDRIC ≥ 6.4 Gy group; in stage ⅢB patients, there were no significant differences in median OS (P = 0.240), LPFS (P = 0.685), or DMFS (P = 0.639) between the two EDRIC subgroups; in stage ⅢCpatients, median LPFSwas significantly longer in the EDRIC ≥ 6.4Gy group (χ2 = 10.36, P = 0.001), while median OS (P = 0.383) and DMFS (P = 0.975) shoowed no significant differences. Conclusions EDRIC is an independent prognostic risk factor for stage Ⅲ NSCLC patients treated with immunotherapy and chemoradiotherapy. A higher EDRIC is associated with poorer prognosis, particularly in stage ⅢA patients with relatively smaller tumor burden. |
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