PD-1单抗联合化疗与化疗治疗Ⅲ-Ⅳ期SMARCA4缺失型非小细胞肺癌的疗效评估及预后分析  

Evaluation of Efficacy and Prognosis Analysis of Stage Ⅲ-Ⅳ SMARCA4-deficient Non-small Cell Lung Cancer Treated by PD-1 Immune Checkpoint Inhibitors plus Chemotherapy and Chemotherapy

作　　者：王新娟 屠蒙 贾红霞[1] 刘宏平 王琰[1] 王一博 姜楠[1] 卢春亚 张国俊[1] Xinjuan WANG;Meng TU;Hongxia JIA;Hongping LIU;Yan WANG;Yibo WANG;Nan JIANG;Chunya LU;Guojun ZHANG(Department of Pulmonary Medicine,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第一附属医院呼吸内科,郑州450000

出　　处：《中国肺癌杂志》2023年第9期659-668,共10页Chinese Journal of Lung Cancer

基　　金：国家自然科学基金项目(No.81874042);河南省呼吸疾病临床医学研究中心资助。

摘　　要：背景与目的SMARCA4突变广泛分布于各种人类肿瘤中,具有SMARCA4突变的非小细胞肺癌(non-small cell lung cancer,NSCLC)至少占所有NSCLC的10%。由于SMARCA4缺失型非小细胞肺癌(SMARCA4-deficient non-small cell lung cancer,SMARCA4-DNSCLC)具有高侵袭性和难治性,且缺乏靶向药物治疗的敏感位点突变,常规放疗和靶向治疗难以改善患者预后,联合或不联合免疫治疗仍是其主要治疗方案,但对于SMARCA4-DNSCLC的有效治疗方案仍存在争议。本研究旨在探讨程序性死亡受体1(programmed cell death 1,PD-1)单抗联合化疗与化疗在Ⅲ-Ⅳ期SMARCA4-DNSCLC患者中的疗效及预后。方法回顾性分析46例Ⅲ-Ⅳ期SMARCA4-DNSCLC患者的一般资料,并探讨其预后的影响因素,按治疗方案将其分为PD-1单抗联合化疗组及化疗组,对两组患者进行疗效评估和生存分析。结果SMARCA4-DSCLC多发生于男性吸烟患者。PD-1单抗联合化疗组与化疗组间的客观缓解率(76.5%vs 69.0%,P=0.836)及疾病控制率(100.0%vs 89.7%,P=0.286)差异无统计学意义;PD-1单抗联合化疗组1年生存率为62.7%,化疗组为46.0%;PD-1单抗联合化疗组与化疗组中位无进展生存期(progression-free survival,PFS)差异具有统计学意义(9.3个月vs 6.1个月,P=0.048)。Cox回归分析结果显示治疗方案及吸烟史是Ⅲ-Ⅳ期SMARCA4-DNSCLC患者PFS的独立影响因素,家族史是Ⅲ-Ⅳ期SMARCA4-DNSCLC患者总生存期的独立影响因素。结论治疗方案是Ⅲ-Ⅳ期SMARCA4-DNSCLC患者预后的影响因素,PD-1单抗联合化疗患者预后可能更好。Background and objective The SMARCA4 mutation has been shown to account for at least 10%of non-small cell lung cancer(NSCLC).In the present,conventional radiotherapy and targeted therapy are difficult to improve outcomes due to the highly aggressive and refractory nature of SMARCA4-deficient NSCLC(SMARCA4-DNSCLC)and the absence of sensitive site mutations for targeted drug therapy,and chemotherapy combined with or without immunotherapy is the main treatment.Effective SMARCA4-DNSCLC therapeutic options,however,are still debatable.Our study aimed to inves-tigate the efficacy and prognosis of programmed cell death 1(PD-1)immune checkpoint inhibitors(ICIs)in combination with chemotherapy and chemotherapy in patients with stage Ⅲ-Ⅳ SMARCA4-DNSCLC.Methods 46 patients with stage Ⅲ-Ⅳ SMARCA4-DNSCLC were divided into two groups based on their treatment regimen:the chemotherapy group and the PD-1 ICIs plus chemotherapy group,and their clinical data were retrospectively analyzed.Efficacy assessment and survival analysis were performed in both groups,and the influencing factors for prognosis were explored for patients with SMARCA4-DNSCLC.Results Male smokers are more likely to develop SMARCA4-DNSCLC.There was no significant difference in the objective response rate(76.5%vs 69.0%,P=0.836)between chemotherapy and the PD-1 ICIs plus chemotherapy or the disease control rate(100.0%vs 89.7%,P=0.286).The one-year overall survival rate in the group with PD-1 ICIs plus chemotherapy was 62.7%,and that of the chemotherapy group was 46.0%.The difference in median progression-free survival(PFS)between the PD-1 ICIs plus chemotherapy group and the chemotherapy group was statistically significant(9.3 mon vs 6.1 mon,P=0.048).The results of Cox regression analysis showed that treatment regimen and smoking history were independent influencing factors of PFS in patients with stage Ⅲ-Ⅳ SMARCA4-DNSCLC,and family history was an individual influencing factor of overall survival in patients with stage Ⅲ-Ⅳ SMARCA4-DNSCLC.Conclusion T

关 键 词：肺肿瘤 SMARCA4 免疫检查点抑制剂 化疗 预后 COX比例风险模型 

分 类 号：R734.2[医药卫生—肿瘤]