中国西南地区2省10个地州市晚期肺癌免疫治疗现状分析

Status of immunotherapy for advanced lung cancer in 10 cities of 2 provinces in southwest China

目的分析中国西南地区10个地(州)市晚期肺癌免疫治疗分布情况,为制定晚期肺癌的防治策略提供参考依据。方法收集2018-01-01-2022-05-31于中国西南地区2省10个地(州)市19家医院经免疫治疗的晚期肺癌患者资料,使用Excel 2019及SPSS 29.0分析数据,采用描述性统计学方法对其基线特征及药物不良反应发生情况进行分层分析。结果本研究共纳入1043例经免疫治疗的晚期肺癌患者,主要分布在遵义市、遂宁市和六盘水市等10个地(州)市的医院。所有纳入患者年龄23~94岁,中位年龄61岁。其中男801例(76.80%),既往具有吸烟史患者609例(58.38%),城镇居住患者631例(60.50%),企事业单位人员436例(41.80%);肺鳞癌413例(39.59%),肺腺癌449例(43.04%),小细胞肺癌132例(12.67%),其他病理类型49例(4.70%),Ⅳ期患者900例(86.29%);美国东部肿瘤协作组(ECOG)评分0~2分患者1015例(97.41%),驱动基因阳性患者176例(16.87%);程序性死亡蛋白配体-1(PD-L1)检测率17.16%,程序性死亡蛋白-1(PD-1)抑制剂使用率95.78%,PD-1/PD-L1抑制剂一线使用率55.99%,PD-1/PD-L1抑制剂联合治疗占80.54%,国产PD-1/PD-L1抑制剂使用率90.13%,适应证用药876例(83.98%)。总体免疫相关不良反应发生率为68.26%,其中3~5级占13.23%,因不良反应导致停药的患者95例(9.10%),因严重免疫相关性肺炎死亡4例,因免疫相关性心肌炎死亡1例。绝大多数免疫相关不良反应经短暂性停药或激素对症治疗后好转。结论中国西南部分地区晚期肺癌免疫治疗存在覆盖患者有限、药物可及性受限及部分医院用药经验相对不足等问题,需进一步改善。

Objective To analyze the distribution of immunotherapy for advanced lung cancer in 10 cities in southwest China and to provide reference for the prevention and treatment of advanced lung cancer.Methods The data of patients with advanced lung cancer treated with immunotherapy from 2018-01-01 to 2022-05-31 in 19 hospitals in 10 prefectures of 2 provinces in Southwest China were collected.Excel 2019 and SPSS 29.0 software were used to process the data.Descriptive statistics was used to analyze the baseline characteristics and the occurrence of adverse drug reactions by stratification.Results A total of 1043 patients with advanced lung cancer were collected in this study,mainly distributed in hospitals of 10 cities,such as Zunyi,Suining and Liupanshui et al.The age of all included patients ranged from 23 to 94 years,with a median age of 61 years.Among them,801 cases(76.80%)were male,609 cases(58.38%)had a history of smoking,631 cases(60.50%)lived in urban areas,and 436 cases(41.80%)were employees of enterprises and public institutions.There were 413 cases(39.59%)of lung squamous cell carcinoma,449 cases(43.04%)of lung adenocarcinoma,132 cases(12.67%)of small cell lung cancer,49 cases(4.70%)of other pathological types,900 cases(86.29%)of stageⅣpatients.There were 1015 patients(97.41%)with ECOG score 0-2 and 176 patients(16.87%)with positive driver gene.The detection rate of programmed death protein ligand-1(PD-L1)was 17.16%,the utilization rate of programmed death protein 1(PD-L1)inhibitor was 95.78%,the first-line utilization rate of PD-1/PD-L1 inhibitor was 55.99%,and the combined treatment rate of PD-1/PD-L1 inhibitor accounted for 80.54%.The utilization rate of domestic PD-1/PD-L1 inhibitors was 90.13%,and 876 cases(83.98%)were used for indications.The overall incidence of immune-related adverse reactions was 68.26%,among which grade 3 to 5 accounted for 13.23%.Ninety-five patients(9.10%)were discontinued due to adverse reactions,4 died due to severe immune-related pneumonia,and 1 died due to immune-related myocarditis.The vast majority of immune-related adverse reactions improved after brief discontinuation or symptomatic hormonal therapy.Conclusions Immunotherapy for advanced lung cancer in some areas of southwest China has some problems,such as limited coverage of patients,limited access to drugs and relatively insufficient drug use experience in some hospitals,which need to be further improved.