不可切除III期非小细胞肺癌诱导化学免疫治疗的疗效及预后分析：单中心回顾性研究

Efficacy and prognostic analysis of induction chemoimmunotherapy in unresectable stage Ⅲ non-small cell lung cancer: a single-center retrospective study.

期刊: Lung Cancer
PMID: 42617307
原文: PubMed ↗
发布日期: 2026-08-19

作者

Xia Gan — Department of Radiation Oncology, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013, Hunan, China; Hunan Key Laboratory of Translational Radiation Oncology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan Province, China.
Zhengzheng Yu — Department of Radiation Oncology, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013, Hunan, China; Hunan Key Laboratory of Translational Radiation Oncology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan Province, China.
Lin Zhang — Department of Radiation Oncology, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013, Hunan, China; Hunan Key Laboratory of Translational Radiation Oncology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan Province, China.
Wenji Xie — Department of Radiation Oncology, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013, Hunan, China; Hunan Key Laboratory of Translational Radiation Oncology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan Province, China.
Xiaowen Sun — Department of Radiation Oncology, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013, Hunan, China; Hunan Key Laboratory of Translational Radiation Oncology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan Province, China.
Yue Li — Department of Radiation Oncology, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013, Hunan, China; Hunan Key Laboratory of Translational Radiation Oncology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan Province, China.
Jianing Fang — Department of Radiation Oncology, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013, Hunan, China; Hunan Key Laboratory of Translational Radiation Oncology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan Province, China.
Yanxian Li — Department of Radiation Oncology, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013, Hunan, China; Hunan Key Laboratory of Translational Radiation Oncology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan Province, China.
Yating Liu — Department of Radiation Oncology, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013, Hunan, China; Hunan Key Laboratory of Translational Radiation Oncology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan Province, China.
Zhongjie Liu — Department of Radiation Oncology, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013, Hunan, China; Hunan Key Laboratory of Translational Radiation Oncology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan Province, China.
Yaning Tang — Department of Radiation Oncology, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013, Hunan, China; Hunan Key Laboratory of Translational Radiation Oncology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan Province, China.
Can Zhou — Department of Radiation Oncology, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013, Hunan, China; Hunan Key Laboratory of Translational Radiation Oncology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan Province, China.
Zhuolong Xie — Department of Radiation Oncology, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013, Hunan, China; Hunan Key Laboratory of Translational Radiation Oncology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan Province, China.
Wen Yao — Department of Radiation Oncology, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013, Hunan, China; Hunan Key Laboratory of Translational Radiation Oncology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan Province, China.
Shuyu Ouyang — Department of Radiation Oncology, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013, Hunan, China; Hunan Key Laboratory of Translational Radiation Oncology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan Province, China.
Jing Zhang — Department of Radiation Oncology, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013, Hunan, China; Hunan Key Laboratory of Translational Radiation Oncology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan Province, China.
Pan Chen — Hunan Key Laboratory of Translational Radiation Oncology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan Province, China.
Hui Wang — Department of Radiation Oncology, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013, Hunan, China; Hunan Key Laboratory of Translational Radiation Oncology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan Province, China. Electronic address: wanghui@hnca.org.cn.
Huai Liu — Department of Radiation Oncology, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013, Hunan, China; Hunan Key Laboratory of Translational Radiation Oncology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan Province, China. Electronic address: liuhuai@hnca.org.cn.

作者单位

Department of Radiation Oncology, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013, Hunan, China; Hunan Key Laboratory of Translational Radiation Oncology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan Province, China.
Hunan Key Laboratory of Translational Radiation Oncology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan Province, China.
Department of Radiation Oncology, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013, Hunan, China; Hunan Key Laboratory of Translational Radiation Oncology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan Province, China. Electronic address: wanghui@hnca.org.cn.
Department of Radiation Oncology, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013, Hunan, China; Hunan Key Laboratory of Translational Radiation Oncology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan Province, China. Electronic address: liuhuai@hnca.org.cn.

摘要

中文

诱导化学免疫治疗联合根治性放化疗（CRT）是治疗不可切除III期非小细胞肺癌（NSCLC）的一种有前景的方法。然而，该治疗方案的安全性、疗效和预后标志物仍有待确定。本单中心回顾性队列纳入了2020年1月至2022年10月接受根治性胸部放疗联合免疫检查点抑制剂（ICIs）治疗的不可切除III期NSCLC患者。放疗前接受化学免疫治疗的患者被归类为诱导ICIs（iICIs），放疗后接受免疫治疗的患者为巩固ICIs（cICIs）。主要终点是无进展生存期（PFS）。进行了倾向评分匹配（1：1）。在iICIs组中，放疗前进行了TNM重新分期和基于CT的肿瘤体积评估。在168例接受根治性放疗的患者中（iICIs，n=111；cICIs，n=57），中位随访48.2个月，iICIs组的中位PFS更长（35.6 vs 23.7个月；p=0.035），匹配后仍更长（36.1 vs 22.9个月；p=0.019），而总生存期相似。iICIs组和cICIs组的≥3级肺炎发生率分别为3.6%和5.2%。在iICIs组中，观察到诱导治疗后分期降级（T4：56.3%→14.6%；IIIC期：22.2%→2.9%），中位大体肿瘤体积从101.3 cm3降至32.3 cm3（中位相对减少：60.9%）。诱导后较大的残余肿瘤体积独立预测较短的PFS（HR=2.12；p=0.032），而较大的肿瘤体积减少独立预测较长的PFS（HR=0.38；p=0.002）和OS（HR=0.26；p=0.001）。iICIs与更长的PFS、放疗前明显降期和肿瘤体积减少相关。诱导后体积学提供了独立的预后分层，可为iICIs策略中的个体化决策提供信息。

English

Induction chemoimmunotherapy combined with definitive chemoradiotherapy (CRT) represents a promising approach for unresectable stage III non-small cell lung cancer (NSCLC). Nevertheless, the safety, efficacy, and prognostic markers for this treatment regimen remain to be established. This single-center retrospective cohort included unresectable stage III NSCLC treated with definitive thoracic radiotherapy plus immune checkpoint inhibitors (ICIs) from January 2020 to October 2022. Patients receiving chemo-immunotherapy before radiotherapy were classified as induction ICIs (iICIs), and those receiving immunotherapy after thoracic CRT as consolidation ICIs (cICIs). The primary endpoint was progression-free survival (PFS). Propensity score matching (1:1) was performed. TNM restaging and CT-based tumor volume were assessed before radiotherapy in the iICIs group. Among 168 patients treated with definitive radiotherapy (iICIs, n = 111; cICIs, n = 57), with a median follow-up of 48.2 months, median PFS was longer with iICIs (35.6 vs 23.7 months; p = 0.035) and remained longer after matching (36.1 vs 22.9 months; p = 0.019), while overall survival was similar. Grade ≥ 3 pneumonitis occurred 3.6% and 5.2% in the iICIs and cICIs groups, respectively. In the iICIs group, downstaging after induction therapy was observed (T4: 56.3%→14.6%; stage IIIC: 22.2%→2.9%), with median gross tumor volume reduced from 101.3 to 32.3 cm3 (median relative reduction: 60.9%). Larger post-induction residual tumor volume independently predicted shorter PFS (HR = 2.12; p = 0.032), whereas greater tumor-volume reduction independently predicted longer PFS (HR = 0.38; p = 0.002) and OS (HR = 0.26; p = 0.001). iICIs was associated with longer PFS, substantial pre-radiotherapy downstaging and tumor-volume reduction. Post-induction volumetrics provided independent prognostic stratification and may inform individualized decisions within the iICIs strategy.

分类与指标

研究类型: 临床研究
病种: 肺癌
JCR 分区: Q1
影响因子: 5.3
新锐分区: 2区