KRAS突变晚期非小细胞肺癌患者免疫检查点抑制剂疗效观察

Efficacy of immune checkpoint inhibitors in patients with KRAS-mutated advanced non-small cell lung cancer

目的探讨KRAS突变的晚期非小细胞肺癌(NSCLC)患者接受免疫检查点抑制剂(ICIs)的疗效。方法收集2018-01-05-2020-11-30山东省肿瘤医院确诊的793例ⅢB~Ⅳ期NSCLC患者临床资料。将其中123例KRAS突变患者纳入研究。Kaplan-Meier法进行生存分析,评估KRAS突变患者不同治疗方式的总生存期(OS)和无进展生存期(PFS)。结果纳入分析的123例KRAS突变患者中,肺腺癌115例(93.50%),Ⅳ期98例(79.67%),有吸烟史的患者71例(57.72%)。38例(30.89%)患者接受ICIs治疗,85例(69.11%)患者接受化疗。接受ICIs治疗的KRAS突变患者OS优于化疗患者(45.2个月vs 13.5个月,HR=2.950,95%CI:7.751~19.316,P=0.001),且无论一线(HR=2.950,95%CI:7.751~19.316,P=0.027)或后线(HR=2.950,95%CI:7.751~19.316,P=0.011)接受ICIs治疗,患者的OS均获益。在不同的治疗方式中,ICIs联合治疗组OS未达到统计学数据,ICIs单药组OS为45个月,化疗联合抗肿瘤血管治疗组为16个月,单用化疗组为13个月,HR=6.259,95%CI:12.966~37.501,P=0.007。结论ICIs治疗是KRAS突变晚期NSCLC患者延长OS的独立预后因素,KRAS突变的晚期NSCLC患者能从ICIs中获益,且ICIs联合治疗患者的OS获益最大。

Objective To explore the efficacy of immune checkpoint inhibitors(ICIs)in patients with KRAS-mutated advanced non-small cell lung cancer(NSCLC).Methods Clinical data of 793 patients with stageⅢB-ⅣNSCLC diagnosed at Shandong Cancer Hospital from January 5,2018 to November 30,2020 were collected.Totally 123 patients with KRAS mutations were included in the study.Survival analysis by Kaplan-Meier method to evaluate overall survival(OS)and progression-free survival(PFS)of KRAS-mutated patients with different treatment modalities.Results Of the 123 patients with KRAS mutations included in the analysis,115(93.50%)were diagnosed with lung adenocarcinoma,98(79.67%)were in stageⅣ,and 71(57.72%)had a history of smoking.38(30.89%)patients were treated with ICIs and 85(69.11%)patients received chemotherapy.Patients in the KRAS-mutated population who received ICIs treatment had a better OS than those treated with chemotherapy(45.2 m vs 13.5 m,HR=2.950,95%CI 7.751-19.316,P=0.001).There was a significant benefit in OS whether ICIs was received in first-line(HR=2.950,95%CI:7.751-19.316,P=0.027)or later-line(HR=2.950,95%CI:7.751-19.316,P=0.011).Among the different treatment modalities,OS did not reach statistical data in ICIs combination therapy group,with 45 months in ICIs monotherapy group,16 months in chemotherapy plus anti-tumor vascular therapy group,13 months in single agent chemotherapy group,HR=6.259,95%CI:12.966-37.501,P=0.007.Conclusions ICIs treatment was an independent prognostic factor for prolonged OS in patients with KRAS-mutated advanced NSCLC.The patients with KRAS-mutated advanced NSCLC could benefit from ICIs and patients with ICIs combination therapy had the best OS.