Background: This study aims to assess the real-world impact of advancements in first-line systemic therapies for non-small-cell lung cancer (NSCLC), focusing on the role of driver gene mutations and programmed death-ligand 1 (PD-L1) expression levels. Methods: Conducted across eight medical facilities in Japan, this multicenter, retrospective observational research included 863 patients diagnosed with NSCLC and treated between January 2015 and December 2022. The patients were categorized based on the type of systemic therapy received: cytotoxic agents, molecular targeting agents, immune checkpoint inhibitors, and combination therapies. Comprehensive molecular and immunohistochemical analyses were conducted, and statistical evaluations were performed. Results: The median overall survival (OS) shows significant variations among treatment groups, with targeted therapies demonstrating the longest OS. This study also revealed that high PD-L1 expression was common in the group treated with immune checkpoint inhibitors. Multivariate analysis was used to identify the type of anticancer drug and the expression of PD-L1 at diagnosis as the impactful variables affecting 5-year OS. Conclusions: This study underscores the efficacy of targeted therapies and the critical role of comprehensive molecular diagnostics and PD-L1 expression in affecting OS in NSCLC patients, advocating for their integration into routine clinical practice.
背景：本研究旨在评估非小细胞肺癌一线系统性治疗进展在真实世界中的影响，重点关注驱动基因突变与程序性死亡配体-1表达水平的作用。方法：这项在日本八家医疗机构开展的多中心回顾性观察研究，纳入了2015年1月至2022年12月期间确诊并接受治疗的863例非小细胞肺癌患者。根据接受系统性治疗的类型将患者分为：细胞毒性药物组、分子靶向药物组、免疫检查点抑制剂组及联合治疗组。研究进行了全面的分子与免疫组织化学分析，并实施统计学评估。结果：各治疗组的中位总生存期呈现显著差异，其中靶向治疗组显示出最长的总生存期。本研究同时发现，高PD-L1表达在免疫检查点抑制剂治疗组中较为普遍。通过多变量分析，确诊时使用的抗癌药物类型及PD-L1表达水平被确定为影响5年总生存期的关键变量。结论：本研究证实了靶向治疗的有效性，并强调全面分子诊断与PD-L1表达水平对非小细胞肺癌患者总生存期的重要影响，建议将其纳入常规临床实践。
肿瘤(癌症)患者之家