组织间插植放疗联合PD-1单抗对晚期非小细胞肺癌远期生存的影响及其预后因素分析  

Efficacy of Interstitial Brachytherapy Combined with PD-1 Monoclonal Antibody in Treatment of Advanced Non-Small Cell Lung Cancer and Related Prognostic Factors of Patients

作　　者：卢俊 秦娟 邓佳秀 张加勇 刘建林 潘荣强 LU Jun;QIN Juan;DENG Jiaxiu;ZHANG Jiayong;LIU Jianlin;PAN Rongqiang(Nanchong Central Hospital,Nanchong Hospital of Beijing Anzhen Hospital Affiliated to Capital Medical University,The Second Clinical Medical College of North Sichuan Medical College,Nanchong 637000,China)

机构地区：[1]南充市中心医院,首都医科大学附属北京安贞医院南充医院,川北医学院第二临床医学院,四川南充637000

出　　处：《肿瘤学杂志》2024年第9期738-744,共7页Journal of Chinese Oncology

基　　金：四川省抗癌协会临床科研(齐鲁)基层项目(XH2023-126)。

摘　　要：[目的]探讨组织间插植放疗联合PD-1单抗对晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)患者远期生存的影响及其预后影响因素。[方法]回顾性分析2020年1月至2023年12月诊治的晚期NSCLC患者70例,既往接受一线以上治疗方案后出现疾病进展,患者均接受组织间插植放疗联合PD-1单抗的治疗方案,评估患者的近期疗效以及远期预后。采用Cox多因素分析影响NSCLC患者总生存期(overall survival,OS)的影响因素。[结果]70例患者均接受了组织间插植放疗联合PD-1单抗方案治疗,患者平均治疗周期为(4.62±1.12)个,无完全缓解,部分缓解12例(17.14%),疾病稳定45例(64.29%),疾病进展13例(18.57%),客观缓解率为17.14%,总有效率为81.43%。患者中位无进展生存期为4个月,中位OS为14个月。在治疗过程中未观察到致命性不良反应,患者对治疗的耐受性良好,3~4级严重不良反应患者5例,占比7.14%。Log-rank检验结果为患者ECOG评分0~1分、C反应蛋白≤10 mg/mL、NLR≤5以及PD-L1表达阳性患者有更长OS。Cox多因素分析显示ECOG评分、C反应蛋白、中性粒细胞与淋巴细胞比值以及PD-L1表达量均是NSCLC患者OS的影响因素(P<0.05)。[结论]组织间插植放疗联合PD-1单抗的综合治疗为晚期NSCLC患者提供了一种有效的治疗选择。ECOG评分、C反应蛋白、中性粒细胞与淋巴细胞比值和PD-L1表达均是评估晚期NSCLC患者组织间插植放疗联合PD-1单抗治疗后临床预后的重要指标。[Objective]To investigate the efficacy of interstitial brachytherapy combined with PD-1 monoclonal antibody in treatment of advanced non-small cell lung cancer(NSCLC)and to analyze the influencing factors of patient prognosis.[Methods]Seventy patients with advanced NSCLC,who received a first line or higher treatment regimen and the disease progressed,were from January 2020 to December 2023.All patients un-derwent a treatment regimen of interstitial brachytherapy combined with PD-1 monoclonal antibody.Patients were followed up and the short-term efficacy and long-term outcomes were evaluated.The factors affecting the overall survival(OS)of patients were analyzed with Cox multivariate regression.[Results]Patients received a median treatment cycle of 4.62±1.12,there was no case of complete response,12 cases(17.14%)of partial response,45 cases(64.29%)of stable disease,and 13 cases(18.57%)of progressive disease.The objective response rate was 17.14%,and the total effective rate was 81.43%.The median progression-free survival of the patient was 4 months,and the median OS was 14 months.Patient had good tolerance to the treatment,and no fatal adverse reaction was observed.There were 5 patients with severe adverse reactions of grades 3~4,accounting for 7.14%.The Log-rank test results show that the patients with ECOG score 0~1,C-reactive protein(CRP)≤10 mg/mL,neutrophil-to-lymphocyte ratio(NLR)≤5 and positive PD-L1 had a longer OS.Cox multivariate analysis showed that ECOG score,CRP,NLR and positive PD-L1 were independent influencing factors for OS in NSCLC patients(P<0.05).[Conclusion]The interstitial brachytherapy combined with PD-1 monoclonal antibody provides an effective treatment option for advanced NSCLC patients.ECOG score,CRP NLR,and positive PD-L1 are predictors for clinical outcomes of patients receiving the combination regimen.

关 键 词：非小细胞肺癌 组织间插植放疗 PD-1单抗 生存期 预后 

分 类 号：R734.2[医药卫生—肿瘤]