Thorac Cancer:回顾性分析使用nivolumab治疗获得长期生存的NSCLC患者的相关因素

2022-01-08 yd2015 MedSci原创

研究表明,与ΔNLR ≥1相比,ΔNLR <1是nivolumab治疗的晚期NSCLC患者长期生存的预测因素。

Nivolumab(纳武利尤单抗)是一种免疫检查点抑制剂(ICI),已经改变了晚期非小细胞肺癌(NSCLC)的治疗模式。然而,在接受ICIs治疗的NSCLC患者中,与长期生存相关的因素仍不清楚。因此,来自日本的学者开展了真实世界研究,本研究旨在利用真实世界的数据,评估nivolumab治疗的NSCLC患者中与长期生存相关的临床特征和实验室变化指标。相关结果发表在Thoracic Cancer杂志上。

我们回顾性研究了连续接受nivolumab治疗的ECOG ≤1的晚期NSCLC患者的医疗记录。我们将总生存期(OS)≥3年的患者定义为长期存活者。我们评估了非长期存活者和长期存活者在患者特征和肿瘤反应方面的差异,并对与长期生存相关的因素进行了单变量和多变量分析。

在接受nivolumab治疗的213例NSCLC患者中,162例患者被纳入研究,排除了51例ECOG> 2患者。162例患者中,34例(21%)为长期存活者(OS≥3年),43例(27%)年龄在75岁或以上,30例(19%)有ECOG- PS=0, 31例(19%)有EGFR突变;此外,69例(43%)患者ANC下降,76例(47%)患者淋巴细胞百分比增加,109例(67%)患者ΔNLR<1。

长期生存患者和非长期生存患者有统计学差异的临床特征和指标有:age (p = 0.030), ECOG-PS (p = 0.011), ANC减少 (p = 0.018), 淋巴细胞百分比增加(p = 0.007), 和ΔNLR <1 (p = 0.004)。

总缓解率(ORR)为19%;完全缓解(CR) 4例(2%),部分缓解(PR) 26例(16%),病情稳定(SD) 76例(46%),病情进展(PD) 56例(35%)。长期生存患者的ORR显著高于非长期生存患者(41% vs. 13%;p<0.001)。此外,长期生存患者的疾病控制率(DCR)显著高于非长期生存患者(94% vs. 56%;p<0.001)。

                   疗效评估

在多变量分析中,只有ΔNLR<1 (OR = 3.97, 95% CI: 1.28 12.3, p = 0.017)与长期生存率显著相关。相比之下,年轻(OR = 2.87, 95% CI: 0.92 8.99, p = 0.070)和ECOG-PS 0 (OR = 2.28, 95% CI: 0.92 5.68, p = 0.076)与长期生存率无显著相关性。

              多因素分析

PS=0组和PS=1组患者的OS有显著差异(HR 0.41 [95% CI: 0.24 0.68], p<;0.001;中位OS [mOS] 32.0个月[95% CI: 20.8-未达到] vs. 10.6个月[95% CI: 8.4 - 14.6]), NLR非增加组和NLR增加组(HR 0.38 [95% CI: 0.27 - 0.55], p<0.001;mOS 20.8个月[95% CI: 13.9 27.2] vs 5.7个月[95% CI: 3.3 8.2])。相比之下,年轻组和老年组的OS无显著差异(HR 0.75 [95% CI: 0.51 1.10], p = 0.14)。

            OS亚组分析

综上,研究表明,与ΔNLR ≥1相比,ΔNLR <1是nivolumab治疗的晚期NSCLC患者长期生存的预测因素。

原始出处:

Murakami Y, Tamiya A, Taniguchi Y, Adachi Y, Enomoto T, Azuma K, Inagaki Y, Kouno S, Matsuda Y, Okishio K, Atagi S. Retrospective analysis of long-term survival factors in patients with advanced non-small cell lung cancer treated with nivolumab. Thorac Cancer. 2022 Jan 5. doi: 10.1111/1759-7714.14303. Epub ahead of print. PMID: 34989133.

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    2022-01-28 tamgche
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    2022-11-05 柳叶一刀
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    2022-01-22 yyj062
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    2022-06-22 jklm09
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