Effect of the treatment sequence of chemoradiotherapy combined with immunotherapy as first-line therapy on the prognosis of patients with stage III non-small cell lung cancer
10.3760/cma.j.cn113030-20241022-00408
- VernacularTitle:放化免一线治疗模式对Ⅲ期非小细胞肺癌患者预后的影响
- Author:
Shuguang LI
1
;
Jinrui XU
;
Luanying WU
;
Jingyuan WEN
;
Xiaohan ZHAO
;
Chunyang SONG
;
Ke YAN
;
Youmei LI
;
Shuchai ZHU
;
Wenbin SHEN
Author Information
1. 河北医科大学第四医院放疗科，石家庄 050011
- Publication Type:Journal Article
- Keywords:
Carcinoma, non-small-cell lung;
Locally advanced;
Immune checkpoint inhibitors;
Chemoradiotherapy;
Concurrent;
Treatment sequence;
Prognosis
- From:
Chinese Journal of Radiation Oncology
2025;34(12):1191-1198
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the impact of different treatment sequences of immunotherapy combined with chemoradiotherapy (CRT) as the first-line therapy on the prognosis of patients with stage III non-small cell lung cancer (NSCLC).Methods:Clinical data of 112 patients with stage III NSCLC treated at the Fourth Hospital of Hebei Medical University from January 2019 to December 2021 were retrospectively collected, with follow-up continued until December 31, 2023. According to the sequence of CRT and immune checkpoint inhibitors (ICIs) therapy, patients were divided into 3 groups: ICIs simultaneous with CRT (sICR, n=20), chemotherapy combined with ICIs followed by CRT (CI-CR, n=53), and CRT followed by consolidative ICIs (CR-I, n=39). Analyses were performed before and after propensity score matching (PSM). Survival outcomes were assessed using the Kaplan-Meier method and compared by log-rank tests, and prognostic factors were identified through multivariate Cox regression analysis. Results:The median overall survival (OS) and progression-free survival (PFS) for the entire cohort were 30.1 months (95% CI: 21.4-38.9) and 12.8 months (95% CI: 9.14-16.1), respectively. Before PSM: No significant differences were observed in OS and PFS among the 3 groups ( χ2=0.18, 1.05; P=0.669, 0.305). However, OS in the sICR and CR-I groups was significantly better than that in the CI-CR group ( χ2=4.43, 6.11; P=0.035, 0.013). After PSM: Each group included 17 patients. There were no significant differences in OS or PFS among the 3 groups ( χ2=2.50, 2.74; P=0.287, 0.254), and pairwise comparisons also showed no significant differences. Multivariate Cox regression analysis revealed that clinical stage ( HR=3.392, 95% CI: 1.215-9.470, P=0.020), number of immunotherapy cycles ( HR=0.312, 95% CI: 0.100-0.972, P=0.044), and treatment response ( HR=6.566, 95% CI: 1.705-25.284, P=0.006) were independent prognostic factors for OS. After PSM, the numbers of patients with grade ≥2 treatment-related adverse events were 13 in the sICR group, 10 in the CI-CR group, and 9 in the CR-I group, with no significant differences among them ( χ2=2.181, P=0.336). Conclusions:First-line immunotherapy combined with chemoradiotherapy showed favorable clinical efficacy in locally advanced NSCLC compared to other studies, but the treatment sequence did not significantly affect prognosis. It is recommended that immunotherapy be administered for at least four cycles.
