PD-1抑制剂治疗晚期肺肉瘤样癌的疗效及预后因素分析

Analysis of the efficacy and prognostic factors of PD-1 inhibitors in advanced pulmonary sarcomatoid carcinoma

目的:探讨PD-1抑制剂治疗晚期肺肉瘤样癌的疗效及影响预后的因素。方法:采用Kaplan-Meier和多因素回归分析方法,回顾性分析我院53例随访资料记录完整的晚期肺肉瘤样癌患者的生存情况及预后因素。采用描述性统计方法分析患者的临床及治疗特征,定性资料以例数(n)和率(%)描述。结果:53例患者在接受免疫治疗2个月后的客观缓解率(objective response rate,ORR)和疾病控制率(disease control rate,DCR)分别为32.1%和83.0%。PD-1抑制剂联合治疗组的ORR和DCR均高于PD-1抑制剂单药治疗组(P<0.05)。PD-1抑制剂联合靶向药物组在2个月和6个月时的DCR分别为88.9%和50.0%,而PD-1抑制剂联合化疗组在2个月和6个月时的DCR分别89.2%和85.7%。53例患者的中位无进展生存期(median progression-free survival,mPFS)为7.7个月,中位总生存期(median overall survival,mOS)为17.8个月。PD-1抑制剂联合靶向药物组和PD-1抑制剂联合化疗组的mPFS和mOS均高于PD-1抑制剂单药组(6个月vs 2.4个月,P<0.001,16.2个月vs 8.7个月,P<0.001;8个月vs 2.4个月,P<0.001,19.7个月vs 8.7个月,P<0.001)。美国东部肿瘤协作组(Eastern Cooperative Oncology Group,ECOG)体能状况(performance status,PS)评分、MET14外显子跳跃突变、治疗方案是PFS的独立预后因素。ECOG PS评分、MET14外显子跳跃突变、脑转移、治疗方案是OS的独立预后因素。结论:对于晚期肺肉瘤样癌患者,PD-1抑制剂联合化疗或靶向治疗比免疫单药治疗更有效。PD-1抑制剂联合化疗组在早期疾病控制率的效果更为明显,为未来晚期肺肉瘤样癌免疫联合化疗的应用提供了新的思路。

Objective:To analyze the efficacy and prognostic factors of PD-1 inhibitors in advanced pulmonary sarcomatoid carcinoma.Methods:The survival rate and prognostic factors of 53 patients with advanced pulmonary sarcomatoid carcinoma,who had complete follow-up data,were retrospectively assessed by Kaplan-Meier analysis and multivariate regression analysis.Descriptive statistical methods were used to analyze the clinical and treatment characteristics of the patients,and qualitative data were described by the number of cases(n)and rate(%).Results:The objective response rate(ORR)and disease control rate(DCR)of 53 patients at 2 months after receiving immunotherapy were 32.1%and 83.0%,respectively.The ORR and DCR in the PD-1 inhibitor combination group were higher than those in the PD-1 inhibitor monotherapy group(P<0.05).The DCRs of the PD-1 inhibitor plus targeted therapy group at 2 and 6 months were 88.9%and 50.0%,respectively,while the DCRs at 2 and 6 months of the PD-1 inhibitor plus chemotherapy group were 89.2%and 85.7%,respectively.The median progression-free survival(mPFS)of the 53 participants was 7.7 months,and the median overall survival(mOS)was 17.8 months.The mPFS and mOS of the PD-1 inhibitor plus targeted therapy group and PD-1 inhibitor plus chemotherapy group were higher than those of PD-1 inhibitor monotherapy group(6 vs 2.4 months,P<0.001,16.2 vs 8.7 months,P<0.001;8 vs 2.4 months,P<0.001,19.7 vs 8.7 months,P<0.001,respectively).Eastern Cooperative Oncology Group(ECOG)performance status(PS)score,MET exon14 skipping,and treatment options were independent prognostic factors for PFS.ECOG PS score,MET exon14 skipping,brain metastases,and treatment options were independent prognostic factors for OS.Conclusion:For patients with advanced pulmonary sarcomatoid carcinoma,PD-1 inhibitor combined with chemotherapy or targeted therapy is more effective than immunomonotherapy.The effect of PD-1 inhibitor combined with chemotherapy is more obvious in the early disease control rate,providing new ideas for the future application of immune and chemotherapy of advanced pulmonary sarcomatoid carcinoma.