驱动基因阴性非小细胞肺癌脑转移免疫治疗联合放疗疗效分析

张群; 周士祥; 时雪玲; 余定玥; 周莹; 于佳琪; 李多杰

doi:10.16766/j.cnki.issn.1674-4152.003826

驱动基因阴性非小细胞肺癌脑转移免疫治疗联合放疗疗效分析

doi: 10.16766/j.cnki.issn.1674-4152.003826

蚌埠医科大学第一附属医院放疗科，安徽蚌埠 233004

基金项目:

安徽高校自然科学研究重点项目 2022AH051511

蚌埠医学院自然科学基金重点项目 2021byzd173

详细信息

通讯作者:
李多杰，E-mail：liduojie@163.com

中图分类号: R734.2 R730.58
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- 文章访问数: 34
- HTML全文浏览量: 20
- PDF下载量: 2
- 被引次数: 0
出版历程
- 收稿日期: 2024-06-01
- 网络出版日期: 2025-02-13

Analysis of the efficacy of combined immunotherapy and radiotherapy in patients with brain metastasis from driver-gene negative non-small cell lung cancer

Department of Radiotherapy, the First Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui 233004, China

摘要

摘要: 目的探讨免疫治疗联合颅脑放疗对驱动基因阴性非小细胞肺癌(NSCLC)脑转移患者的疗效和安全性。方法选择2020年1月—2023年12月蚌埠医科大学第一附属医院收治的108例NSCLC脑转移患者作为研究对象。根据治疗方法将患者分为单纯颅脑放疗组(单一组，60例)和免疫联合颅脑放疗组(联合组，48例)，比较单一组和联合组的疗效和毒副作用。此外，将联合组患者根据颅脑放疗模式的不同进一步分为A组[全脑放疗(WBRT)]、B组(WBRT联合局部加量放疗)和C组(局部放疗)3个亚组，比较3组不同放疗模式的治疗效果和副作用。结果联合组的颅内客观有效率(iORR)和颅内疾病控制率(iDCR)均高于单一组[54.17%(26/48) vs. 35.00%(21/60)，χ²=3.985, P=0.046；75.00%(36/48) vs. 56.67%(34/60)，χ²=3.930, P=0.047]，治疗期间2组的不良反应均可耐受。联合组各亚组颅内疗效比较显示B组的iORR和iDCR均高于A组(P < 0.001)，毒副作用发生率在3组间差异无统计学意义(P>0.05)。结论免疫治疗联合颅脑放射治疗对驱动基因阴性NSCLC脑转移患者安全有效，提高颅内疾病控制率的同时不增加毒副作用。
- 非小细胞肺癌 /
- 脑转移 /
- 驱动基因阴性 /
- 免疫治疗 /
- 放射治疗
Abstract: Objective Exploring the efficacy and safety of combined immunotherapy and radiotherapy in patients with brain metastasis from driver-gene negative non-small cell lung cancer (NSCLC). Methods A total of 108 NSCLC patients with brain metastasis, admitted to the First Affiliated Hospital of Bengbu Medical University from January 2020 to December 2023, were selected as the research objects. Patients were divided into the cranial radiotherapy group (single group, 60 cases) and the combined immunotherapy plus cranial radiotherapy group (combined group, 48 cases) according to treatment Methods. The efficacy and toxicity of the two groups were compared. In addition, patients in the combined therapy group were further subdivided into three subgroups: group A (whole brain radiotherapy, WBRT), group B (WBRT combined with local dose radiotherapy), and group C (local radiotherapy) according to the different modes of cranial radiotherapy. The treatment outcomes and side effects of the different radiotherapy modes were compared among the subgroups. Results The intracranial Objective response rate (iORR) and disease control rate (iDCR) in the combined therapy group were higher than those of the single therapy group [54.17% (26/48) vs. 35.00% (21/60), χ²=3.985, P=0.046; 75.00% (36/48) vs. 56.67% (34/60), χ²=3.930, P=0.047]. Both groups had tolerable adverse reactions. The comparison of intracranial efficacy among the three subgroups in the combined therapy group showed that the iORR and iDCR of group B were higher than those in the group A (P < 0.001), with no significant difference in the incidence of side effects among the three groups (P>0.05). Conclusion Immunotherapy combined with radiotherapy is effective in patients with brain metastasis from driver gene-negative NSCLC. This combination improves the disease control rate without significantly increasing side effects.
- Non-small cell lung cancer /
- Brain metastasis /
- Driver gene negative /
- Immunotherapy /
- Radiation therapy

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图 1 3种颅脑放疗模式靶区勾画示意图

注：A~D为WBRT靶区勾画示意图，A为CT横断面，B为MRI横断面，C为CT矢状面，D为MRI矢状面；E~H为WBRT联合局部推量放疗靶区勾画示意图，E为CT横断面，F为MRI横断面，G为CT矢状面，H为MRI矢状面；I~L为局部放疗靶区勾画示意图，I为CT横断面，J为MRI横断面，K为CT矢状面，L为MRI矢状面。

Figure 1. Schematic diagram of the target area delineation for three cranial radiotherapy modalities

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表 1 2组NSCLC脑转移患者临床资料比较[例(%)]

Table 1. Comparison of clinical data between two patient groups with brain metastases in NSCLC[cases(%)]

项目	单一组 (n=60)	联合组 (n=48)	χ²值	P值
性别			0.140	0.708
男性	47(78.33)	39(81.25)
女性	13(21.67)	9(18.75)
年龄(岁)			0.438	0.508
< 60	25(41.67)	17(35.42)
≥60	35(58.33)	31(64.58)
BMI			0.270	0.603
< 24	32(53.33)	28(58.33)
≥24	28(46.67)	20(41.67)
吸烟史			0.121	0.728
有	33(55.00)	28(58.33)
无	27(45.00)	20(41.67)
治疗线数			3.590	0.058
1	36(60.00)	20(41.67)
≥2	24(40.00)	28(58.33)
病理类型			3.510	0.061
腺癌	39(65.00)	39(81.25)
非腺癌	21(35.00)	9(18.75)
脑转移瘤数目			2.645	0.104
1~3	32(53.33)	33(68.75)
>3	28(46.67)	15(31.25)

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表 2 2组NSCLC脑转移患者颅内疗效比较[例(%)]

Table 2. Comparison of intracranial efficacy between two patient groups with brain metastases in NSCLC[cases(%)]

组别	例数	CR	PR	SD	PD	iORR	iDCR
单一组	60	0	21(35.00)	13(21.67)	26(43.33)	21(35.00)	34(56.67)
联合组	48	2(4.17)	24(50.00)	10(20.83)	12(25.00)	26(54.17)	36(75.00)
χ²值						3.985	3.930
P值						0.046	0.047

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表 3 2组NSCLC脑转移患者毒副作用比较[例(%)]

Table 3. Comparison of toxic and side effects between two patient groups with brain metastases in NSCLC[cases(%)]

组别	例数	白细胞计数下降	放射性脑损伤	免疫相关性肺炎	反应性毛细血管增生症
单一组	60	17(28.33)	2(3.33)	0	0
联合组	48	12(25.00)	2(4.17)	2(4.17)	23(47.92)
χ²值		0.151			36.529
P值		0.698	0.999^a	0.195^a	< 0.001
注：^a为使用Fisher精确检验。

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表 4 不同放疗模式亚组NSCLC脑转移患者颅内疗效比较[例(%)]

Table 4. Comparison of intracranial efficacy across subgroups with different radiotherapy modalitie[cases(%)]

组别	例数	CR	PR	SD	PD	iORR	iDCR
A组	13	0	3(23.08)	3(23.08)	7(53.85)	3(23.08)	6(46.15)
B组	14	1(7.14)	9(64.29)	3(21.43)	1(7.14)	10(71.43)^a	13(92.86)^a
C组	21	1(4.76)	12(57.14)	4(19.05)	4(19.05)	13(61.90)	17(80.95)
χ²值						7.248	7.661
P值						0.027	0.018
注：与A组比较，^aP < 0.017。

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表 5 不同放疗模式亚组NSCLC脑转移患者毒副作用比较[例(%)]

Table 5. Comparison of toxicity and side effects across subgroups with different radiotherapy modes[cases(%)]

组别	例数	白细胞计数下降	放射性脑损伤	免疫相关性肺炎	反应性毛细血管增生症
A组	13	4(30.77)	0	1(7.69)	8(61.5)
B组	14	5(35.71)	1(7.14)	1(7.14)	6(42.9)
C组	21	3(14.29)	1(47.62)	0	9(42.9)
χ²值					1.326
P值		0.326^a	0.999^a	0.311^a	0.515
注：^a为采用Fisher精确检验。

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