Ⅲ期非小细胞肺癌病人新辅助化疗联合免疫治疗后无病生存的影响因素分析

Influencing factors of disease-free survival in patients with stage Ⅲ non-small cell lung cancer after neoadjuvant chemotherapy combined with immunotherapy

目的探讨Ⅲ期非小细胞肺癌(NSCLC)病人新辅助化疗联合免疫治疗后无病生存的影响因素。方法我院2014年5月~2019年5月接受新辅助化疗联合免疫治疗后行根治术的Ⅲ期NSCLC病人200例,在新辅助化疗联合免疫治疗后随访3年,根据3年无病生存情况分为无病生存组(76例)及非无病生存组(124例),采用Kaplan-Meier法分析无病生存期(DFS),采用Cox回归模型分析影响NSCLC新辅助化疗联合免疫治疗后行根治术病人无病生存的因素。结果200例病人3年无病生存76例,无病生存率为38.00%,中位DFS为21个月。无病生存组与非无病生存组吸烟史、分化程度、肿瘤直径、EGFR基因突变、ALK基因表达、新辅助化疗联合免疫治疗的疗效及术后辅助化疗等比较,差异有统计学意义(P<0.05)。Cox回归模型分析显示,吸烟史(OR=2.016,P=0.004)、低分化(OR=2.125,P=0.001)、肿瘤直径>3 cm(OR=1.958,P=0.007)、EGFR基因突变(OR=2.305,P=0.002)、ALK基因阳性表达(OR=2.450,P=0.004)、新辅助化疗联合免疫治疗后未缓解(OR=1.820,P=0.005)均为新辅助化疗联合免疫治疗后行NSCLC根治术病人无病生存的危险因素,术后辅助化疗(OR=1.728,P=0.006)为新辅助化疗联合免疫治疗后行NSCLC根治术病人无病生存的保护因素。结论NSCLC新辅助化疗联合免疫治疗后行根治术病人无病生存与吸烟史、分化程度、肿瘤直径、EGFR基因突变、ALK基因表达、新辅助化疗联合免疫治疗的疗效及术后辅助化疗等因素有关。

Objective To explore the influencing factors of disease-free survival(DFS)in patients with stage Ⅲ non-small cell lung cancer(NSCLC)after neoadjuvant chemotherapy combined with immunotherapy.Methods A total of 200 patients with stage Ⅲ NSCLC undergoing radical operation after neoadjuvant chemotherapy combined with immunotherapy in the hospital were enrolled between May 2014 and May 2019.All were followed up for 3 years after neoadjuvant chemotherapy combined with immunotherapy.According to 3-year DFS,they were divided into DFS group(n=76)and non-DFS group(n=124).DFS was analyzed by Kaplan-Meier method,and its influencing factors were analyzed by Cox regression model.Results In the 200 patients,there were 96 cases(38.00%)with 3-year DFS,and the median DFS was 21 months.The differences in smoking history,differentiation degree,tumor diameter,EGFR gene mutation,expression of ALK gene,curative effect of neoadjuvant chemotherapy combined with immunotherapy,and postoperative adjuvant chemotherapy between the two groups were statistically significant(P<0.05).The analysis of Cox regression model showed that smoking history(OR=2.016,P=0.004),low differentiation(OR=2.125,P=0.001),tumor diameter>3 cm(OR=1.958,P=0.007),EGFR gene mutation(OR=2.305,P=0.002),positive expression of ALK gene(OR=2.450,P=0.004)and non-remission after neoadjuvant chemotherapy combined with immunotherapy(OR=1.820,P=0.005)were risk factors of DFS,while postoperative adjuvant chemotherapy(OR=1.728,P=0.006)was a protective factor.Conclusion In patients with stage Ⅲ NSCLC undergoing radical operation after neoadjuvant chemotherapy combined with immunotherapy,DFS is related to smoking history,differentiation degree,tumor diameter,EGFR gene mutation,expression of ALK gene,curative effect of neoadjuvant chemotherapy combined with immunotherapy and postoperative adjuvant chemotherapy.