年龄校正查尔森合并症指数对老年晚期非小细胞肺癌患者抗PD-1免疫治疗的预后评估  

Prognostic value of age-adjusted Chalson Comorbidity Index for anti-PD-1 immunotherapy in elderly patients with advanced non-small cell lung cancer

作　　者：邵佳康 周宇欣 张正 张雅迪 赵晓[2] 刘传玲 刘茗露 范运龙 杨子仲 李智 王玉颖 田坤 贾谷和 赵卫红 焦顺昌[2] SHAO Jiakang;ZHOU Yuxin;ZHANG Zheng;ZHANG Yadi;ZHAO Xiao;LIU Chuanling;LIU Minglu;FAN Yunlong;YANG Zizhong;LI Zhi;WANG Yuying;TIAN Kun;JIA Guhe;ZHAO Weihong;JIAO Shunchang(Chinese PLA Medical School,Beijing 100853,China;Department of Oncology,the First Medical Centre,Chinese PLA General Hospital,Beijing 100853,China;Medical College of Nankai University,Tianjin 300071,China)

机构地区：[1]解放军医学院,北京100853 [2]解放军总医院第一医学中心肿瘤内科,北京100853 [3]南开大学医学院,天津300071

出　　处：《解放军医学院学报》2022年第2期121-127,共7页Academic Journal of Chinese PLA Medical School

基　　金：国家“十三五”重大专项课题项目(2018ZX09201013)。

摘　　要：背景据报道,合并症可能与非小细胞肺癌(non-small cell lung cancer,NSCLC)患者的生存及预后相关,而鲜有研究评价合并症与免疫治疗的关系。目的 评估年龄校正查尔森合并症指数(age-adjusted Charlson comorbidity index,a CCI)与使用抗PD1免疫检查点抑制剂治疗的老年晚期NSCLC患者临床预后的关系。方法 回顾性分析解放军总医院第一医学中心2014年1月1日-2019年12月31日收治的年龄≥70岁且经抗PD-1免疫治疗的ⅢA~ⅣB期NSCLC患者的临床资料。使用单因素和多因素Cox回归分析不同临床特征与预后的关系,使用Kaplan-Meier生存曲线分析不同因素对患者生存的影响。结果 共有118例患者纳入研究,男性94例,平均年龄为74.7岁。低a CCI评分组(<9分)的中位无进展生存期(progression-free survival,PFS)为10.6个月(95%CI:6.0~15.2),高a CCI评分组(≥9分)的中位PFS为6.1个月(95%CI:4.8~7.4);低a CCI评分组的中位总生存期(overall survival,OS)为33.9个月(95%CI:13.7~54.1),高a CCI评分组的中位OS为11.7个月(95%CI:9.5~13.9);低a CCI评分组的生存预后(PFS和OS)明显优于高a CCI评分组(P均<0.01)。Cox回归分析提示美国东部肿瘤协作组行为状态(Eastern Cooperative Oncology Group performance status,ECOG PS)评分和a CCI与老年NSCLC患者预后独立关联。结论 利用a CCI评估的合并症负担可以预测应用抗PD1免疫治疗的老年晚期NSCLC患者的预后,但还需进一步的大规模前瞻性研究来验证。Background It has been reported that comorbidities may be associated with survival and prognosis of patients with nonsmall cell lung cancer(NSCLC), but few studies have evaluated the relationship between comorbidities and immunotherapy.Objective To assess the association between the age-adjusted Charlson Comorbidity Index(a CCI) and the clinical prognosis outcomes of elderly patients with advanced NSCLC treated with anti-PD-1 immune checkpoint inhibitors. Methods Clinical data about patients aged 70 years or older with NSCLC diagnosed as ⅢA to ⅣB who were admitted to the First Medical Center of Chinese PLA General Hospital and treated with anti-PD-1 immunotherapy from January 1, 2014 to December 31, 2019 were retrospectively analyzed. The relationship between different clinical characteristics and prognosis were analyzed using univariate and multivariate Cox regression analyses, and the impact of different factors on patients’ survival was analyzed using Kaplan-Meier survival curves. Results A total of 118 patients were enrolled, with 94 males and a mean age of 74.7 years old. The median progressionfree survival(PFS) was 10.6 months(95% CI, 6.0-15.2) in the low a CCI score group(<9 points) and 6.1 months(95% CI, 4.8-7.4)in the high a CCI score group(≥9 points);the median overall survival(OS) was 33.9 months(95% CI, 13.7-54.1) in the low a CCI score group and 11.7 months(95% CI, 9.5-13.9) in the high a CCI score group, and the survival prognosis indicators(PFS and OS) in the low a CCI score group were superior to those in the high a CCI score group(P<0.01, respectively). Cox regression analysis suggested that Eastern Cooperative Oncology Group performance status(ECOG PS) and a CCI were associated with the prognosis of the elderly NSCLC patients. Conclusion Comorbidity burden assessed by a CCI can predict the prognosis of elderly patients with advanced NSCLC treated with anti-PD1 immunotherapy, but further large-scale prospective studies are needed to validate this.

关 键 词：非小细胞肺癌 年龄校正查尔森合并症指数 免疫治疗 老年人 PD-1单抗 

分 类 号：R734.2[医药卫生—肿瘤]