摘要
目的探讨既往胸部放疗在信迪利单抗联合多西他赛二线以上治疗Ⅳ期无基因突变非小细胞肺癌(NSCLC)病人预后中的临床价值。方法回顾性分析2019年2月至2020年1月潍坊医学院附属医院收治的Ⅳ期难治性无基因突变NSCLC病人73例,失访3例,最终共70例纳入研究。所有病人接受信迪利单抗、多西他赛联合治疗。依据既往是否行胸部放疗进行分组:放疗组28例、无放疗组42例,比较两组病人近期疗效、无进展生存时间(PFS)、不良反应等。用Kaplan-Meier法进行统计学分析。应用Cox比例风险模型分析影响病人预后的因素。结果放疗组的总有效率和疾病控制率与无放疗组比较,差异无统计学意义(P>0.05)。70例病人均随访13个月以上,放疗组和无放疗组病人中位无进展生存时间(mPFS)分别为7.9个月[95%CI:(7.1,8.7)]和6.5个月[95%CI:(5.4,7.6)](log-rank P=0.004);单因素分析结果示:既往胸部放疗是改善PFS预后的保护性因素(P<0.05),体力状况东部肿瘤协作组(ECOG)评分不佳、脑转移是影响PFS预后的危险性因素(P<0.05)。多因素分析结果示:既往胸部放疗是改善PFS预后的独立保护性因素(P<0.05),ECOG评分不佳、脑转移是影响PFS预后的独立危险性因素(P<0.05)。两组所有级别不良反应发生率、3级及以上不良反应发生率分别比较,差异无统计学意义(P>0.05)。结论信迪利单抗联合多西他赛二线以上治疗Ⅳ期无基因突变NSCLC有良好的疗效和安全性;既往胸部放疗有助于接受免疫检查点抑制剂(ICIs)治疗的Ⅳ期NSCLC病人预后的判断,且与不良反应的发生无关。
Objective To investigate the clinical significance of previous thoracic radiotherapy in the prognosis of patients with stageⅣnon-small cell lung cancer(NSCLC)without gene mutation in treatment of sentilimab combined with docetaxel second-line or above drugs.Methods A retrospective analysis was performed on 73 patients with stageⅣrefractory NSCLC patients without gene mutation who were admitted to the Affiliated Hospital of Weifang Medical College from February 2019 to January 2020.In the study,3 patients were lost to follow-up,and 70 patients were finally analyzed.All patients received sentilimab combined with docetaxel,and they were assigned into radiotherapy group(n=28)and no radiotherapy group(n=42)according to previous thoracic radiotherapy.The short-term efficacy,progression-free survival(PFS)and adverse events were compared between two groups.Statistical analysis was conducted using Kaplan-Meier method.The factors affecting the prognosis of patients were evaluated using Cox proportional hazards model.Results There were no significant differences in the total effective rate and disease control rate between the radiotherapy group and the non-radiotherapy group(P>0.05).The 70 patients were followed up for more than 13 months.The median progression-free survival(mPFS)of the radiotherapy group and no radiotherapy group were 7.9 months[95%CI:(7.1,8.7)]and 6.5 months[95%CI:(5.4,7.6)](log-rank P=0.004).The results of univariate analysis showed that previous thoracic radiotherapy was identified as a protective factor for improving the prognosis of PFS(P<0.05),while poor performance status eastern cooperative oncology group(ECOG)score and brain metastasis were identified as the risk factors affecting the prognosis of PFS(P<0.05).Multivariate analysis showed that previous thoracic radiotherapy was identified as an independent protective factor for improving the prognosis of PFS(P<0.05),while poor ECOG score and brain metastasis were identified as independent risk factors affecting the prognosis of PFS(P<0.05).Comparison of all grade adverse events,grade 3 and above adverse events between the two groups showed no statistical difference(P>0.05).Conclusions Sentilimab combined with docetaxel second-line or above drugs has good efficacy and safety in the treatment of stageⅣNSCLC patients without gene mutation.Previous thoracic radiotherapy is helpful in predicting the the prognosis of stageⅣNSCLC patients treated with immune checkpoint inhibitors(ICIs)and is not related to the adverse events.
作者
郑纪红
韩强
冯金月
宋代颖
郭英
刘伊辉
ZHENG Jihong;HAN Qiang;FENG Jinyue;SONG Daiying;GUO Ying;LIU Yihui(Clinical Medical College,Weifang Medical College,Weifang,Shandong 261000,China;Department of Endocrinology,The Affiliated Hospital of Weifang Medical College,Weifang,Shandong 261000,China;Department of Radiation Oncology,The Affiliated Hospital of Weifang Medical College,Weifang,Shandong 261000,China)
出处
《安徽医药》
CAS
2022年第9期1865-1869,共5页
Anhui Medical and Pharmaceutical Journal
关键词
癌
非小细胞肺
信迪利单抗
免疫治疗
既往胸部放疗
多西他赛
Carcinoma,non-small-cell lung
Sentilimab
Immunotherapy
Previous thoracic radiotherapy
Docetaxel
