| 毛文卓,胡伟国,宋启斌.免疫检查点抑制剂在小细胞肺癌脑转移患者中的疗效分析及列线图的构建[J].肿瘤学杂志,2023,29(4):300-307. |
| 免疫检查点抑制剂在小细胞肺癌脑转移患者中的疗效分析及列线图的构建 |
| Efficacy of Immune Checkpoint Inhibitors Therapy in Small-Cell Lung Cancer Patients with Brain Metastases Undergoing Chemoradiotherapy and Construction of Prognostic Nomogram |
| 投稿时间：2023-03-03 |
| DOI：10.11735/j.issn.1671-170X.2023.04.B008 |
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| 中文关键词: 小细胞肺癌 脑转移 免疫检查点抑制剂 列线图 |
| 英文关键词:brain metastases immune checkpoint inhibitors small cell lung cancer nomogram |
| 基金项目: |
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| 中文摘要: |
| 摘 要：［目的］ 评估免疫检查点抑制剂（immune checkpoint inhibitors，ICIs）在接受标准放化疗（chemoradiotherapy，CRT）的小细胞肺癌脑转移患者中的疗效与临床获益，并构建生存预后列线图。［方法］ 回顾性分析2017年10月至2022年10月确诊为小细胞肺癌脑转移并接受标准CRT治疗的131例患者的临床病历资料。根据是否联合ICIs治疗分为标准治疗组（A组）和免疫治疗组（B组），A组87例患者，仅接受针对脑转移的标准CRT治疗，B组44例，在CRT基础上联合了至少4个周期ICIs治疗。使用 Kaplan-Meier法评估患者脑转移后总生存期和颅内无进展生存期。采用Cox 比例风险回归模型对影响小细胞肺癌脑转移患者预后的相关因素进行单因素和多因素分析，通过最优子集回归和Lasso回归辅助筛选变量后使用C指数构建列线图及ROC曲线。［结果］ 随访日期截止至2022年12月31日，A、B两组的中位总生存期分别为12.6个月和20.1个月（HR=0.63，95%CI：0.42～0.96，P<0.001)，颅内中位无进展生存期分别为7.4个月和10.8个月（HR=0.69，95%CI：0.46～1.01，P<0.001），颅内疾病客观缓解率分别为70.1%和88.6%（P=0.018），颅内疾病控制率分别为90.8%和95.4%（P=0.550）。多因素分析显示免疫治疗是独立预后因素。根据Cox比例风险回归、最优子集回归、Lasso回归结果，以患者年龄、ECOG评分、脑转移灶数量、脑转移发生时序、颅外转移、胸部放疗、免疫治疗为预测因子，构建列线图，模型预测C指数为0.788 (95%CI：0.726～0.800)，经内部验证显示模型预测能力及校准性较好。［结论］ 免疫治疗联合CRT对小细胞肺癌脑转移患者有显著疗效。基于上述指标建立的列线图模型可作为小细胞肺癌脑转移患者预后的预测模型，为更多研究提供参考。 |
| 英文摘要: |
| Abstract：［Objective］ To evaluate the efficacy of immune checkpoint inhibitors(ICIs) therapy in small cell lung cancer brain metastases(SCLC-BM) patients with standard chemoradiotherapy(CRT)， and to construct a survival prediction nomogram. ［Methods］ The clinical data of 131 SCLC-BM patients received CRT from October 2017 to October 2022 were retrospectively reviewed， including 87 cases receiving CRT only(group A) and 44 cases receiving at least four cycles of additional ICIs therapy(group B). Overall survival(OS) and intracranial progression-free survival(IPFS) were assessed by Kaplan-Meier analysis. The relevant factors affecting the prognosis of SCLC-BM patients were analyzed with univariate and multivariate Cox proportional hazards regression. Best subsets regression and Lasso regression were used to screen variables， than a prognosis nomogram was constructed and evaluated with C-index and ROC curve. ［Results］ Patients were followed-up until December 31， 2022， the median OS was 12.6 months and 20.1 months(HR=0.63， 95%CI：0.42～0.96， P<0.001)， the median IPFS was 7.4 months and 10.8 months(HR=0.69， 95%CI：0.46～1.01， P<0.001)， the intracranial objective response rate was 70.1% and 88.6%(P=0.018)， the intracranial disease control rate was 90.8% and 95.4%(P=0.550)， in group A and group B， respectively. Multivariate analyses showed that immunotherapy was an independent prognostic factor. According to the results of the Cox proportional hazards regression， best subsets regression and Lasso regression， the age， ECOG grade， number of BM， time sequence of BM， extracranial metastases， chest radiation and immunotherapy were taken as predictive factors， a prognostic nomogram was constructed， the C-index was 0.788(95%CI：0.726～0.800)，through robustness test， the model showed nice predictive ability and have good calibrability. ［Conclusion］ Immunotherapy plus CRT showed promising efficacy for SCLC-BM patients. The nomogram model based on the above indicators can be used as a prediction model for the prognosis of SCLC-BM patients. |
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