Concurrent chemoradiotherapy plus immunotherapy for locally advanced non-small-cell lung cancer: clinical efficacy and prognostic analysis.

IF 1.7 4区 医学 Q3 MEDICINE, RESEARCH & EXPERIMENTAL
American journal of translational research Pub Date : 2025-02-15 eCollection Date: 2025-01-01 DOI:10.62347/EAAF2821
Xiangning Lan, Xuge Zhou, Kejun Dai, Qiang Wang
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引用次数: 0

Abstract

Objective: To evaluate the efficacy of concurrent chemoradiotherapy (CCRT) combined with immunotherapy (IT) for locally advanced non-small-cell lung cancer (LA-NSCLC). Short-term treatment outcomes during the two-year follow-up were recorded, and 2-year survival data were collected to analyze prognosis and identify factors affecting short-term outcome. Additionally, a predictive model was developed.

Methods: We conducted a retrospective analysis of 90 LA-NSCLC patients admitted between February 2018 and February 2020. Patients were grouped according to their treatment regimens: 45 patients treated with 4-6 cycles of CCRT followed by 1 year of Sintilimab therapy were assigned to the observation group, and 45 patients treated with cisplatin/carboplatin + albumin-bound paclitaxel for 4-6 cycles after CCRT were assigned to the control group. Short-term adverse reactions were recorded for both groups. Patients were followed up after 4-6 cycles of IT or chemotherapy, and short-term efficacy and toxicity were evaluated. During the 2-year follow-up, overall survival (OS) and progression-free survival (PFS) were recorded, and survival curves were plotted. The Cox proportional hazards model was used to identify factors influencing PFS in the observation group, and a predictive model was developed. The predictive value of relevant indicators for prognosis was assessed using receiver operating characteristic (ROC) curves.

Results: The observation group showed superior short-term efficacy, with higher objective response rates (ORR) and disease control rates (DCR) compared to the control group (both P < 0.05). Regarding toxicity, the control group exhibited more severe adverse effects, particularly grade III and higher gastrointestinal reactions, leukopenia, thrombocytopenia, and anemia (all P < 0.05). The PFS was significantly higher in the observation group than that of the control group (P < 0.05). Additionally, the incidence of pneumonia was higher in the observation group, but it demonstrated better 2-year OS (P < 0.05). Cox multivariate analysis revealed that factors influencing PFS in the observation group included distant metastasis, tumor differentiation, platelet-to-lymphocyte ratio (PLR), and prealbumin (PAB). ROC analysis showed that the areas under the curve (AUC) for predicting prognosis based on PLR and PAB were 0.662 and 0.774, respectively, and the combined AUC of these indicators was 0.812.

Conclusions: CCRT combined with IT is an effective treatment for LA-NSCLC, improving survival outcomes. The predictive model developed may help assess prognosis and guide early clinical intervention. Attention should be given to pneumonia prevention and management during IT. Moreover, the combination of PLR and PAB enhances prognostic prediction for NSCLC patients undergoing CCRT plus IT.

同步放化疗加免疫治疗局部晚期非小细胞肺癌:临床疗效和预后分析。
目的:评价同步放化疗(CCRT)联合免疫治疗(IT)治疗局部晚期非小细胞肺癌(LA-NSCLC)的疗效。记录2年随访期间的短期治疗结果,收集2年生存数据,分析预后,确定影响短期结果的因素。此外,还建立了预测模型。方法:我们对2018年2月至2020年2月入院的90例LA-NSCLC患者进行了回顾性分析。根据患者的治疗方案进行分组,45例患者接受4-6个周期CCRT + 1年辛替单抗治疗为观察组,45例患者在CCRT后接受顺铂/卡铂+白蛋白结合紫杉醇治疗4-6个周期为对照组。记录两组患者的短期不良反应。术后随访4 ~ 6个周期,评价近期疗效和毒副作用。随访2年,记录总生存期(OS)和无进展生存期(PFS),绘制生存曲线。采用Cox比例风险模型识别观察组PFS的影响因素,并建立预测模型。采用受试者工作特征(ROC)曲线评价相关指标对预后的预测价值。结果:观察组近期疗效优于对照组,客观有效率(ORR)和疾病控制率(DCR)均高于对照组(P < 0.05)。毒性方面,对照组不良反应更严重,特别是III级胃肠道反应、白细胞减少、血小板减少、贫血发生率更高(均P < 0.05)。观察组患者PFS显著高于对照组(P < 0.05)。观察组肺炎发生率较高,但2年OS较对照组好(P < 0.05)。Cox多因素分析显示,影响观察组PFS的因素包括远处转移、肿瘤分化、血小板与淋巴细胞比值(PLR)、前白蛋白(PAB)。ROC分析显示,基于PLR和PAB预测预后的曲线下面积(AUC)分别为0.662和0.774,综合AUC为0.812。结论:CCRT联合IT治疗LA-NSCLC是一种有效的治疗方法,可改善生存结局。建立的预测模型有助于评估预后,指导早期临床干预。IT期间应注意肺炎的预防和管理。此外,PLR和PAB联合应用可提高接受CCRT + IT的NSCLC患者的预后预测。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
American journal of translational research
American journal of translational research ONCOLOGY-MEDICINE, RESEARCH & EXPERIMENTAL
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552
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