非小细胞肺癌合并慢性阻塞性肺疾病患者免疫检查点抑制剂治疗的真实世界临床分析

Real-world clinical analysis of immune checkpoint inhibitor therapy in patients withnon-small cell lung cancer complicated by chronic obstructive pulmonary disease

    摘要
  • 摘要:
    目的 探讨非小细胞肺癌（non-small cell lung cancer，NSCLC）合并慢性阻塞性肺疾病（chronic obstructive pulmonary disease，COPD）简称“慢阻肺”患者应用免疫检查点抑制剂（immune checkpoint inhibitors，ICIs）治疗的真实世界疗效、安全性及预后的影响因素。
    方法 收集2018年1月至2024年10月于北京大学首钢医院接受过ICIs治疗的100例Ⅲ～Ⅳ期NSCLC患者的临床病理资料，根据是否合并COPD，分为肺癌合并COPD组（LC-COPD组）52例和非COPD组48例，回顾性分析两组患者ICIs治疗的疗效、安全性及预后的影响因素。生存分析采用Kaplan-Meier法，生存率的比较采用Log-rank检验。
    结果 接受ICIs治疗的LC-COPD组患者中位无进展生存（progression-free survival，PFS）时间长于非COPD组（11.97个月 vs. 7.83个月，P=0.022），两组的总生存（overall survival，OS）时间差异无统计学意义（22.37个月 vs. 16.80个月，P=0.110）。与LC-COPD组和肺功能正常患者相比，比率保留的肺功能减损（preserved ratio impaired spirometry，PRISm）组患者免疫治疗的中位PFS和中位OS均较差（均P<0.05）。多因素分析结果显示，合并COPD、程序性细胞死亡蛋白配体-1（programmed cell death-ligand 1，PD-L1）表达、治疗线数及中性粒细胞比淋巴细胞比值（neutrophil to lymphocyte ratio，NLR）与PFS相关（P<0.05）；PD-L1表达、免疫治疗疗效、NLR及是否吸入糖皮质激素（ICS）与OS相关（P<0.05）。安全性方面两组免疫治疗相关不良反应发生率相当。
    结论 在临床治疗中，NSCLC合并慢阻肺患者接受ICIs治疗相较于非慢阻肺患者PFS获益更良好，且安全性可控。肺癌合并PRISm人群ICIs治疗预后不佳。PD-L1表达、呼出气一氧化氮、NLR及ICSs使用可能作为肺癌合并COPD患者免疫治疗疗效的潜在预测标志物。

     

    Abstract:
    Objective  To investigate the efficacy, safety, and prognostic factors associated with immune checkpoint inhibitors (ICIs) in patients with non-small cell lung cancer (NSCLC) comorbid with chronic obstructive pulmonary disease (COPD).
    Methods  Clinical and pathological data were collected from 100 patients with stage Ⅲ-Ⅳ NSCLC who received one or more cycles of ICI treatment at Peking University Shougang Hospital between January 2018 and October 2024 were collected. Based on COPD diagnosis, patients were assigned into the NSCLC with COPD (LC-COPD, n=52) and NSCLC without COPD (non-COPD, n=48) groups. The efficacy, safety, and prognostic factors of ICIs treatment were retrospectively analyzed in both groups. Survival analysis was performed using the Kaplan-Meier method, and survival rates were compared using the Log-rank test.
    Results Among the patients who received ICIs treatment, median progression-free survival (PFS) in the LC-COPD group was longer than that in the non-COPD group (11.97 vs. 7.83 months, P=0.022), but no significant difference was detected in overall survival (OS) (22.37 vs. 16.80 months, P=0.110). Compared with the LC-COPD group and patients with normal lung function, the preserved ratio impaired spirometry (PRISm) subgroup showed worse median PFS and OS following immunotherapy (all P<0.05). Multivariate analysis revealed that COPD comorbidity, programmed cell death-ligand 1 (PD-L1) expression, treatment line, and neutrophil to lymphocyte ratio (NLR) were independently associated with PFS (P<0.05). Additionally, PD-L1 expression, immunotherapy efficacy, NLR, and inhaled corticosteroids (ICS) use were significantly associated with OS (P<0.05). The incidence of immune-related adverse events was comparable between the two groups.
    Conclusions ICI treatment demonstrated a greater positive impact on PFS in patients with NSCLC and COPD than in patients with NSCLC alone in a real-world study, with a good safety profile in both groups. NSCLC patients with PRISm showed poorer outcomes following ICI treatment. PD-L1 expression, FeNO, NLR, and ICS may serve as potential predictive biomarkers for immunotherapy efficacy in NSCLC patients with COPD.

     

    • HTML全文
    • 参考文献(23)
    • 相关文章
    • 施引文献
  • 资源附件(0)

/

返回文章
返回