Background: Durvalumab consolidation after chemoradiotherapy (CRT) is a standard treatment for locally advanced non-small cell lung cancer (NSCLC). However, studies on immunological and nutritional markers to predict progression-free survival (PFS) and overall survival (OS) are inadequate. Systemic inflammation causes cancer cachexia and negatively affects immunotherapy efficacy, which also reflects survival outcomes. Patients and Methods: We retrospectively investigated 126 patients from seven institutes in Japan. Results: The modified Glasgow Prognostic Score (mGPS) values, before and after CRT, were the essential predictors among the evaluated indices. A systemic inflammation-based prognostic risk classification was created by combining mGPS values before CRT, and C-reactive protein (CRP) levels after CRT, to distinguish tumor-derived inflammation from CRT-induced inflammation. Patients were classified into high-risk (n= 31) and low-risk (n= 95) groups, and the high-risk group had a significantly shorter median PFS of 7.2 months and an OS of 19.6 months compared with the low-risk group. The hazard ratios for PFS and OS were 2.47 (95% confidence interval [CI]: 1.46–4.19,p< 0.001) and 3.62 (95% CI: 1.79–7.33,p< 0.001), respectively. This association was also observed in the subgroup with programmed cell death ligand 1 expression of ≥50%, but not in the <50% subgroup. Furthermore, durvalumab discontinuation was observed more frequently in the high-risk group than in the low-risk group. Conclusion: Combining pre-CRT mGPS values with post-CRT CRP levels in patients with locally advanced NSCLC helps to predict the PFS and OS of durvalumab consolidation after CRT.
背景：在放化疗（CRT）后使用度伐利尤单抗进行巩固治疗是局部晚期非小细胞肺癌（NSCLC）的标准疗法。然而，关于预测无进展生存期（PFS）和总生存期（OS）的免疫及营养标志物的研究尚不充分。全身性炎症会导致癌症恶病质并对免疫治疗效果产生负面影响，这也反映了患者的生存结局。患者与方法：我们回顾性分析了来自日本七家机构的126例患者。结果：在评估的各项指标中，CRT前后的改良格拉斯哥预后评分（mGPS）值是关键的预测因子。通过结合CRT前的mGPS值和CRT后的C反应蛋白（CRP）水平，建立了一种基于全身炎症的预后风险分级，以区分肿瘤源性炎症与CRT诱导的炎症。患者被分为高风险组（n=31）和低风险组（n=95），高风险组的中位PFS（7.2个月）和OS（19.6个月）均显著短于低风险组。PFS和OS的风险比分别为2.47（95%置信区间[CI]：1.46–4.19，p<0.001）和3.62（95% CI：1.79–7.33，p<0.001）。这种关联在程序性细胞死亡配体1表达≥50%的亚组中同样存在，但在<50%的亚组中未观察到。此外，高风险组比低风险组更频繁地出现度伐利尤单抗停药情况。结论：在局部晚期NSCLC患者中，结合CRT前的mGPS值和CRT后的CRP水平有助于预测CRT后度伐利尤单抗巩固治疗的PFS和OS。
肿瘤(癌症)患者之家