| Background and objective:In recent years,the rapid development of immune checkpoint inhibitors,represented by programmed cell death protein-1(PD-1)and its ligand(PD-L1)inhibitors,has changed the first-line treatment pattern for advanced non-small cell lung cancer(NSCLC).Our study aims to evaluate the efficacy of first-line immunotherapy for locally advanced or metastatic NSCLC in the real world by retrospectively analyzing 183 patients who received immunotherapy as their first-line treatment in the oncology department of the First Hospital of Jilin University,and explore clinical factors that may affect prognosis.Methods:The clinical data of 183 locally advanced or metastatic NSCLC patients who received first-line immunotherapy in our oncology department from January 1,2017 to April 1,2022 and met the inclusion and exclusion criteria of this retrospective study were collected through the Hai Tai electronic medical record system.The efficacy of patients was evaluated according to Response Evaluation Criteria In Solid Tumors(RECIST)version 1.1.The data were statistically described and analyzed by the SPSS 26.0 software.Kaplan-Meier method was used to draw the survival curve.The effects of various clinical factors on progression free survival(PFS)and overall survival(OS)were further analyzed,and the independent influencing factors of prognosis were screened.Results:1.Among the advanced NSCLC patients receiving immunotherapy,153 patientsV(83.6%)received immune checkpoint inhibitors(ICIs)combined with chemotherapy,25 patients(13.7%)received ICIs monotherapy,and 5 patients(2.7%)received ICIs combined with chemotherapy and antiangiogenic therapy.The disease control rate(DCR)was 88.5%,the objective response rate(ORR)was 51.9%,the median progression-free survival(PFS)was 13.2 months,and the median overall survival(OS)was 25.97 months.2.Among the 153 patients receiving first-line ICIs combined with chemotherapy,the DCR was 90.8%,the ORR was 52.9%,the median PFS was 13.7 months,and the median OS was 24.1 months.(1)Among them,148 patients received ICIs combined with double-agent chemotherapy,and their DCR was 91.2%,ORR was 53.4%,median PFS was 13.87 months,and median OS was 25.47 months.5 patients received ICIs combined with single-agent chemotherapy,and their DCR was 80%,ORR was 40%,median PFS was7.5 months,and median OS was 9.6 months.(2)Univariate analysis of factors affecting PFS showed that patients with ECOG PS 0 and no liver metastasis had significantly prolonged PFS(P<0.05).Multivariate analysis of factors affecting PFS showed that ECOG score and liver metastasis were independent factors affecting PFS,and patients with ECOG PS 0 and no liver metastasis had significantly prolonged PFS(P<0.05).(3)Univariate analysis of factors affecting OS showed that patients with ECOG PS 0 had significantly prolonged OS(P<0.05).Multivariate analysis of factors affecting OS showed that gender and ECOG score were independent factors affecting OS,and male patients and patients with ECOG PS 0 had significantly prolonged OS(P<0.05).3.Among the 25 patients receiving first-line ICIs monotherapy,the DCR was72%,the ORR was 48%,the median PFS was 9.5 months,and the median OS was27.83 months.(1)Among the patients receiving ICIs monotherapy,17 patients had PD-L1 expression ≥50%,with DCR of 76.5%,ORR of 47.1%,median PFS of 13.2 months,and median OS of 27.83 months.8 patients had PD-L1 expression in the range of1%-49%,with DCR of 62.5%,ORR of 50%,median PFS of 3.93 months,and median OS of 9.93 months.9 patients received domestically produced ICIs monotherapy,with DCR of 88.9%,ORR of 55.6%,median PFS of 5.8 months,and median OS of 27.83 months.(2)Univariate analysis of factors affecting PFS showed no clinical features affecting PFS.Multivariate analysis of factors affecting PFS showed that liver metastasis and ECOG score were independent factors affecting PFS,and patients with no liver metastasis and ECOG PS 0 had significantly prolonged PFS(P<0.05).(3)Univariate analysis of factors affecting OS showed that male patients had a significantly longer OS(P<0.05)in a univariate analysis.Multivariate analysis of factors affecting OS showed that gender and liver metastasis were independent factors affecting OS,and that male patients and patients without liver metastasis had a significantly longer OS(P<0.05).4.5 patients who received first-line immunotherapy combined with chemotherapy and antiangiogenic therapy had a DCR of 100%,ORR of 40%,median PFS of 14.67 months,and median OS of 16.23 months.Conclusion:1.Among patients treated with immunotherapy combined with chemotherapy,the treatment effect of immunotherapy combined with double-agent chemotherapy is better than that of immunotherapy combined with single-agent chemotherapy.The independent factors affecting PFS are ECOG score and liver metastasis,while the independent factors affecting OS are gender and ECOG score.2.Among patients treated with immunotherapy alone,the treatment effect of PD-L1 expression ≥50% is better than that of PD-L1 expression in the range of1%-49%.The independent factors affecting PFS are ECOG score and liver metastasis,and the independent factors affecting OS are gender and liver metastasis.3.The patients treated with domestic immune drugs have achieved good curative effect.Certain therapeutic effects have been achieved in patients with ECOG score of 2 and aged ≥65 years who receive immunotherapy combined with single-agent chemotherapy,or in patients with PD-L1 expression range of 1%-49%who receive immunotherapy monotherapy.This group is usually ignored by large clinical trials,but the sample size is limited,and further exploration is needed in the real world. |
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