广泛期小细胞肺癌二线化疗联合免疫治疗的疗效分析

Efficacy analysis of second-line chemotherapy combined with immunotherapy in extensive-stage small cell lung cancer

目的 探讨广泛期小细胞肺癌(ES-SCLC)一线化疗联合免疫治疗进展后二线化疗联合免疫治疗的疗效。方法 回顾性分析2019年1月至2022年12月于福建省肿瘤医院确诊的46例一线标准化疗联合免疫治疗进展后二线化疗±免疫治疗ES-SCLC患者的疗效,其中男43例,女3例;年龄(61.33±7.87)岁。一线方案治疗进展后二线化疗联合免疫治疗组(免疫跨线组) 27例,一线方案治疗进展后二线化疗未联合免疫治疗组(免疫未跨线组) 19例,分析两组患者临床病理特征、近期疗效和生存的差异。结果 免疫跨线组和免疫未跨线组患者的性别、年龄、肿瘤转移部位、使用免疫药物的差异均无统计学意义(均P>0.05)。免疫跨线组患者一线治疗后部分缓解(PR) 23例,疾病稳定(SD) 4例;二线治疗后,PR 2例,SD 13例,疾病进展(PD) 12例。免疫未跨线组患者一线治疗后PR 14例,SD 3例,PD 2例;二线治疗后,PR 1例,SD 7例,PD 11例。免疫跨线组二线治疗后的客观缓解率(ORR)为7.4%(2/27),疾病控制率(DCR)为55.6%(15/27);免疫未跨线组ORR为5.3%(1/19),DCR为42.1%(8/19);两组患者二线治疗后ORR和DCR的差异均无统计学意义(P值分别为0.772和0.549)。免疫跨线组患者二线治疗后中位无进展生存时间较免疫未跨线组长(分别为88和67d),但差异无统计学意义(P=0.454);免疫跨线组患者二线治疗后总生存时间较免疫未跨线组有延长趋势(分别为382和335d,P=0.104)。结论ESSCLC一线化疗联合免疫治疗进展后二线化疗联合免疫治疗相比单纯使用化疗,具有一定的延长患者无进展生存时间和总生存时间的趋势。

Objective To explore the efficacy of second-line chemotherapy combined with immunotherapy after the progression of first-line standard chemotherapy combined with immunotherapy in extensive-stage small cell lung cancer(ES-SCLC).Methods A retrospective analysis was conducted on 46 patients diagnosed with ES-SCLC at Fujian Cancer Hospital from January 2019 to December 2022.Among them,there were 43 males and 3 females,with a mean age of(61.33±7.87) years.27 cases in the secondline chemotherapy combined with immunotherapy group(immunotherapy cross-line group) after progression of first-line treatment,and 19 cases in the second-line chemotherapy without immunotherapy group(immunotherapy non-cross-line group) after progression of first-line treatment were analyzed for differences in clinical pathological characteristics,short-term treatment efficacy,and survival.Results There were no statistically significant differences in gender,age,tumor metastasis sites,and use of immunotherapy between the immunotherapy cross-line group and the immunotherapy noncross-line group(all P> 0.05).In the immunotherapy cross-line group,after first-line treatment,23 patients achieved partial response(PR) and 4 patients had stable disease(SD);after second-line treatment,2 patients had PR,13 had SD,and 12 had progressive disease(PD).In the immunotherapy non-cross-line group,after first-line treatment,14 patients had PR,3 had SD,and 2 had PD;after second-line treatment,1 patient had PR,7 had SD,and 11 had PD.The objective response rate(ORR) after second-line treatment was 7.4%(2/27) in the immunotherapy cross-line group and 5.3%(1/19) immunotherapy non-cross-line group,with disease control rates(DCR) of 55.6%(15/27) and 42.1%(8/19),respectively.There were no statistically significant differences in ORR and DCR between the two groups(P=0.772 and P=0.549,respectively).The median progression-free survival(PFS) after second-line treatment was longer in the immunotherapy cross-line group than in the immunotherapy non-cross-line group(88 days vs.67 days),but the difference was not statistically significant(P=0.454).The total survival time after second-line treatment showed a trend of extension in the immunotherapy cross-line group compared to the immunotherapy non-cross-line group(382 days vs.335 days,P=0.104).Conclusion Second-line chemotherapy combined with immunotherapy after the progression of first-line immunotherapy in ES-SCLC has a certain trend of prolonging patient PFS and OS compared to chemotherapy alone.