Overall survival according to immunotherapy and radiation treatment for metastatic non-small-cell lung cancer: a National Cancer Database analysis
Overall survival according to immunotherapy and radiation treatment for metastatic non-small-cell lung cancer: a National Cancer Database analysis
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DOI：
10.1186/s13014-019-1222-3
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发表时间：
2019-01-28
影响因子：
3.6
通讯作者：
Koshy, Matthew
中科院分区：
文献类型：
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作者：
Foster, Corey C.;Sher, David J.;Koshy, Matthew
背景：临床前研究表明联合放射免疫治疗可增强抗肿瘤活性。我们假设，放射（RT）+免疫治疗将与改善总生存期（OS）相比，免疫治疗或化疗单独为新诊断的转移性非小细胞肺癌（NSCLC）的患者。方法：国家癌症数据库查询2013年至2014年接受化疗或免疫治疗的IV期NSCLC患者。RT模式分为颅内和/或颅外部位的立体定向放射治疗（SRT）或非SRT外射束RT（EBRT）。OS采用Kaplan-Meier法和考克斯比例风险模型进行分析。结果：共纳入44，498例患者（13%免疫治疗，46.8% EBRT和4.7% SRT）。在多变量分析中，免疫治疗（风险比[HR]：0.81，95%置信区间[CI]：0.78-0.83）和SRT（HR：0.78，95% CI：0.78 - 0.83）。70-0.78）与OS改善独立相关;然而，SRT +免疫治疗的相互作用项不显著（p = 0.89）。对于免疫治疗患者，无RT、EBRT和SRT的中位OS分别为14.5、10.9和18。多变量分析显示，EBRT（HR：1.37，95% CI：1.29-1.46）和SRT（HR：0.78，95% CI：0.66-0.93）与OS相关。在SRT亚组中，免疫治疗和化疗的中位OS分别为18.2和14.3个月（p = 0.004），多变量分析显示免疫治疗（HR：0.82，95% CI：0.69-0.98）与OS相关。此外，对于接受SRT的患者，生物有效剂量（BED）> 60戈伊与OS改善独立相关（HR：0.79，95% CI：0.70-0.90，p < 0.0001），多变量分析显示BED与全身治疗之间存在显著相互作用（p = 0.008）。接受SRT +免疫治疗的患者的高生存率强烈支持在随机试验中进行评估。
Background: Preclinical studies suggest enhanced anti-tumor activity with combined radioimmunotherapy. We hypothesized that radiation (RT) + immunotherapy would associate with improved overall survival (OS) compared to immunotherapy or chemotherapy alone for patients with newly diagnosed metastatic non-small-cell lung cancer (NSCLC).Methods: The National Cancer Database was queried for patients with stage IV NSCLC receiving chemotherapy or immunotherapy from 2013 to 2014. RT modality was classified as stereotactic radiotherapy (SRT) to intra- and/or extracranial sites or non-SRT external beam RT (EBRT). OS was analyzed using the Kaplan-Meier method and Cox proportional hazards models.Results: In total, 44,498 patients were included (13% immunotherapy, 46.8% EBRT, and 4.7% SRT). On multivariate analysis, immunotherapy (hazard ratio [HR]:0.81, 95% confidence interval [CI]:0.78-0.83) and SRT (HR:0.78, 95% CI:0. 70-0.78) independently associated with improved OS; however, the interaction term for SRT + immunotherapy was insignificant (p = 0.89). For immunotherapy patients, the median OS for no RT, EBRT, and SRT was 14.5, 10.9, and 18. 2 months, respectively (p < 0.0001), and EBRT (HR:1.37, 95% CI:1.29-1.46) and SRT (HR:0.78, 95% CI:0.66-0.93) associated with OS on multivariate analysis. In the SRT subset, median OS for immunotherapy and chemotherapy was 18.2 and 14.3 months, respectively (p = 0.004), with immunotherapy (HR:0.82, 95% CI:0.69-0.98) associating with OS on multivariate analysis. Furthermore, for patients receiving SRT, biologically effective dose (BED) > 60 Gy was independently associated with improved OS (HR:0.79, 95% CI:0.70-0.90, p < 0.0001) on multivariate analysis with a significant interaction between BED and systemic treatment (p = 0.008).Conclusions: Treatment with SRT associated with improved OS for patients with metastatic NSCLC irrespective of systemic treatment. The high survival for patients receiving SRT + immunotherapy strongly argues for evaluation in randomized trials.