关键词:非小细胞肺癌,骨转移,免疫检查点抑制剂,疗效,影响因素

Abstract:

ObjectiveTo explore the efficacy of immune checkpoint inhibitors （ICIs） on patients with non-small cell lung cancer （NSCLC） and complicated with bone metastases， and the influencing factors of ICIs immunotherapy， in order to provide clinical basis for improving prognosis of patients with advanced NSCLC bone metastases and guiding individualized treatment.MethodsClinical data of 168 patients with NSCLC complicated with bone metastasies admitted to Fujian Provincial Hospital from January 1， 2019 to March 31， 2022 were retrospectively analyzed （including gender， age， smoking history， bone metastasies， pathological types， skeletal related events （SREs）， treatment plan， efficacy， progression-free survival （PFS）， overall survival （OS） etc.〕， survival data of patients were obtained during follow-up. Survival analysis （Kaplan-Meier survival time curve） was used to evaluate the efficacy of ICIs， and univariate analysis （Log-Rank test） and multivariate analysis （COX regression model） were used to predict the factors affecting the efficacy of ICIs.ResultsOf the 168 patients with NSCLC bone metastasis， 84 received ICIs. The 1-year survival rate was 71.43% （60/84）， the objective remission rate was 23.81%， and the disease control rate was 84.52%. The median progression-free survival （MPFS） was 11.0 months （P= 0.018）， and the median survival time （MST） was 18.3 months （P= 0.045） in the ICIs treatment group. The difference was statistically significant. Univariate analysis showed the age of onset < 65 years （P= 0.040）， ECOG PS ≤ 1 point at the initial diagnosis （P= 0.006）， no other organ metastasis （P= 0.001）， systemic chemotherapy （P= 0.006）， and that combined immunotherapy （P= 0.012） had longer PFS； at the initial diagnosis， ECOG PS ≤ 1 point （P= 0.043）， no other organ metastasis （P= 0.001）， and that systemic chemotherapy （P= 0.034） had longer OS； Multivariate analysis showed that the PFS and OS （P= 0.012；P= 0.002） of patients with onset age ≥ 65 years were lower than those of patients with onset age < 65 years； the PFS and OS of patients treated with bone modifying drugs were significantly higher than those without bone modifying drugs （P= 0.050；P= 0.035）；the PFS and OS of patients with other organ metastasis were significantly lower than those without other organ metastasis （P= 0.001；P= 0.001）； the PFS of patients with ECOG PS score ≥ 2 at initial diagnosis （P= 0.047） was significantly shorter than the PFS of patients with ECOG PS score ≤ 1 at initial diagnosis.ConclusionICIs significantly prolong PFS and OS in patients with bone metastases from NSCLC； patients with younger age （< 65 years old）， good physical fitness （ECOG PS ≤ 1 point）， no other organ metastasis， and immuno chemotherapy combined with ICIs have better therapeutic effects； older age （≥ 65 years old）， deviation in physical status （ECOG PS ≥ 2 points）， accompanied by other organ metastases， and the progression of patients with bone metastases from lung cancer using ICIs immunotherapy are independent risk factors. Moreover， age at onset， accompanied by other organ metastases are independent predictors of the prognosis of OS after ICIs immunotherapy， while bone modification drug bone therapy is an independent protective factor for PFS and OS in patients with bone metastases from NSCLC treated with ICIs immunotherapy.

Key words:non-small celllung cancer,bone metastasis,immune checkpoint inhibitor,curative effect,influencing factors