帕博利珠单抗治疗晚期非小细胞肺癌反应降低与抗生素预处理的关系

Relationship between reduced response to pabolizumab in treatment of advanced non-small cell lung cancer and antibiotic preconditioning

目的分析抗生素(antibiotic,ATB)预处理与晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)患者帕博利珠单抗治疗反应及预后的关系。方法选择2019年1月至2023年1月我院收治的接受帕博利珠单抗治疗92例晚期NSCLC患者,收集临床数据资料,根据治疗开始前30 d内是否接受ATB预处理,将接受ATB预处理17例为观察组,未接受75例为对照组。记录客观缓解率(objective response rate,ORR)、疾病控制率(disease control rate,DCR)、疾病进展、无进展生存期(progression-free survival,PFS)、总生存期(overall survival,OS)。结果对照组ORR 27例(36.00%)高于观察组2例(11.76%)(P>0.05);对照组DCR 65例(84.00%)高于观察组8例(47.06%)(P<0.05);对照组疾病进展26例(34.67%)低于观察组11例(64.71%)(P<0.05);对照组预后不佳7例(9.33%)低于观察组11例(64.71%)(P<0.05)。经单因素分析,只有肿瘤最大直径≥2.40 cm(OR=1.012,95%CI:1.004~1.951,P=0.043)、ALB≥40.90 g/L(OR=0.406,95%CI:0.172~0.955,P=0.039)和ATB(+)(OR=2.614,95%CI:1.288~5.306,P=0.008)是影响疾病进展的临床因素。多因素COX回归分析发现ATB预处理是病情进展及预后不佳相关的危险因素。Kaplan-Meier绘图分析ATB预处理与晚期NSCLC患者PFS的关系,观察组中位PFS 1.77(0.33~14.00)个月、中位OS 7.17(1.90~14.00)个月短于对照组5.43(0.70~14.03)个月,5.43(2.10~14.47)个月(P<0.05)。结论帕博利珠单抗治疗晚期NSCLC,治疗前30 d内ATB预处理与治疗后的反应降低具有意义。

Objective To analyze the relationship between antibiotic(ATB)pretreatment and the therapeutic response and prognosis of pembrolizumab in patients with advanced non-small cell lung cancer(NSCLC).Methods A total of 92 patients with advanced NSCLC treated with pembrolizumab in our hospital from January 2019 to January 2023 were retrospectively analyzed.The clinical data of the patients were collected,and the patients were divided into ATB(-)group and ATB(+)group according to whether they had received any ATB treatment within 30 days before pembrolizumab treatment.Objective response rate(ORR),disease control rate(DCR),disease progression,progression-free survival(PFS)and overall survival(OS)were recorded.Results There was no significant difference in ORR between the control group 27cases(36.00%)and the observation group 8 cases(11.76%)(P>0.05).The DCR in control group 65 cases(84.00%)was significantly higher than that in observation group 8 cases(47.06%)(P<0.05).Disease progression occurred in 26 patients(34.67%)in the control group and 11 patients(64.71%)in the observation group(P<0.05).Case fatality rate in control group 7 cases(9.33%)lower than observation group 11 cases(64.71%)(P<0.05).Multivariate COX regression analysis found that ATB(+)was the only independent risk factor associated with disease progression and death.Kaplan-Meier mapping analyzed the relationship between ATB preconditioning and PFS in patients with advanced NSCLC.The median PFS in the observation group[1.77(0.33~14.00)months vs.5.43(0.70~14.03)months,P=0.006],the median OS[7.17(1.90~14.00)months vs.5.43(2.10~14.47)months,P=0.016]was significantly shorter than that of the control group.Conclusions In advanced NSCLC patients treated with pembrolizumab,ATB pretreatment within 30 days before treatment is associated with reduced therapeutic response and shorter survival.