晚期非小细胞肺癌患者二线化疗联合免疫治疗与单一化疗的疗效观察  

Efficacy of second-line chemotherapy combined with immunotherapy and single chemotherapy in patients with advanced non-small cell lung cancer

作　　者：叶蓉 乐雯雯 张晨 陶累累 卞伟钢 戴夕超 YE Rong;YUE Wenwen;ZHANG Chen;TAO Leilei;BIAN Weigang;DAI Xichao(Department of Pharmacy,Yancheng School of Clinical Medicine of Nanjing Medical University,Yancheng Third People′s Hospital,Yancheng,Jiangsu 224001,China;Department of Oncology,Yancheng School of Clinical Medicine of Xuzhou Medical University,the First People′s Hospital of Yancheng,Yancheng,Jiangsu 224008)

机构地区：[1]南京医科大学盐城临床医学院,盐城市第三人民医院药学部,江苏盐城224001 [2]徐州医科大学盐城临床学院,盐城市第一人民医院肿瘤科,盐城224008

出　　处：《徐州医科大学学报》2025年第1期63-67,共5页Journal of Xuzhou Medical University

基　　金：江苏省卫生健康委科研项目(Z2021041);盐城市科技计划项目(YK2018017)。

摘　　要：目的 评估晚期非小细胞肺癌(NSCLC)患者二线化疗联合免疫治疗与二线单一化疗的疗效及安全性。方法 选择2019年6月—2021年10月盐城市第一人民医院收治的经一线化疗后进展的NSCLC患者53例,其中接受二线单一化疗者30例(单一化疗组),接受二线化疗联合免疫治疗者23例(联合免疫组)。评估2组患者的疗效,计算客观缓解率(ORR)、疾病控制率(DCR)、无进展生存期(PFS)和总生存期(OS),记录2组NSCLC患者在二线治疗中的不良反应。结果 联合治疗组中完全缓解(CR) 1例、部分缓解(PR)12例、稳定(SD)4例、进展(PD)6例,ORR为56.5%(13/23),DCR为73.9%(17/23);单一治疗组中CR 0例、PR 10例、SD 5例、PD 15例,ORR为33.3%(10/30),DCR为50.0%(15/30)。2组ORR和DCR比较,差异均无统计学意义(P=0.091和0.078)。单一化疗组和联合免疫组的中位PFS分别为5.5个月和7.0个月,差异有统计学意义(P=0.004),且肿瘤淋巴结转移(TNM)分期Ⅲ、Ⅳ期患者在联合免疫治疗中获益更多(P=0.010)。单一化疗组和联合免疫组的中位OS分别为10.0个月和11.0个月,差异有统计学意义(P=0.012),且程序性死亡蛋白配体1(PD-L1)阳性患者在联合免疫治疗中获益更多(P=0.038)。联合免疫组患者的不良反应发生率较单一化疗组未见明显增加(P>0.05)。结论 二线化疗联合免疫治疗后晚期NSCLC患者ORR和DCR与二线单一化疗相似,但远期疗效明显改善。Objective To evaluate the efficacy and safety of second-line chemotherapy combined with immunotherapy versus second-line single chemotherapy in patients with advanced non-small cell lung cancer(NSCLC).Methods A total of 53 NSCLC patients,who had progressed after first-line chemotherapy and were admitted to the First People′s Hospital of Yancheng from June 2019 to October 2021,were selected.Among them,30 patients received second-line single chemotherapy(a single chemotherapy group),and 23 patients underwent second-line chemotherapy combined with immunotherapy(a combined immunotherapy group).Their efficacy were evaluated and the objective response rate(ORR),disease control rate(DCR),progression-free survival(PFS),and overall survival(OS) were calculated.Adverse reactions in the two groups during second-line treatment of NSCLC were recorded.Results In the combined immunotherapy group,there was 1 case of complete response(CR),12 cases of partial response(PR),4 cases of stable disease(SD),and 6 cases of progressive disease(PD),while the ORR was 56.5%(13/23),and the disease control rate(DCR) was 73.9%(17/23).In the single chemotherapy group,there were no cases of CR,10 cases of PR,5 cases of SD,and 15 cases of PD,while the ORR was 33.3%(10/30),and the DCR was 50.0%(15/30).There was no statistical difference in ORR and DCR between the two groups(P=0.091 and P=0.078).The median PFS was 5.5 months for the single chemotherapy group,and 7.0 months for the combined immunotherapy group,with statistical differences(P=0.004).Patients with TNM stages Ⅲ and Ⅳ lymph node metastasis benefited more in the combined immunotheray(P=0.010).The median OS was 10.0 months for the single chemotherapy group,and 11.0 months for the combined immunotherapy group,with statistical differences(P=0.012).PD-L1 positive patients had more benefits in the combined immunotherapy(P=0.038).The incidence of adverse reactions in the combined immunotherapy group did not statistically increase(P>0.05).Conclusions Compared with chemotherapy alone,second-

关 键 词：非小细胞肺癌 免疫检查点抑制剂 化疗 免疫治疗 放疗 

分 类 号：R734.2[医药卫生—肿瘤]