Pembrolizumab, a widely used immune checkpoint inhibitor (ICI), has revolutionized the treatment of non-small cell lung cancer (NSCLC). Identifying unique tumor characteristics in patients likely to respond to pembrolizumab could help the clinical adjudication and development of a personalized therapeutic strategy. In this retrospective study, we reviewed the clinical data and pathological features of 84 NSCLC patients treated with pembrolizumab. We examined the correlation between the clinical and demographic characteristics and the tumor histopathologic features obtained before immunotherapy. The response to pembrolizumab therapy was evaluated via the Response Evaluation Criteria in Solid Tumors (RECIST). The clinical data and cancer tissue characteristics were assessed and compared among three groups according to the following RECIST: the responsive group (RG), the stable disease group (SD), and the progressive disease group (PD), where the RG comprised patients with either a complete response (CR) or a partial response (PR). The overall survival rate of the RG group was significantly higher than the SD and PD groups. In addition, the percentage of pre-treatment viable tumor cell content in the RG and SD groups was significantly higher. At the same time, the extracellular stroma proportion was significantly lower than that of the PD group. The number of tumor-infiltrating lymphocytes (TILs) in the RG group was significantly higher than in the PD group. There were no significant differences in tumor necrosis, the stroma composition, PD-L1 expression level (TPS 1–49% vs. ≥50%), and treatment response. In conclusion, our population of NSCLC patients who experienced positive treatment responses to pembrolizumab therapy had a better prognosis compared to patients with either SD or PD. Moreover, the relative proportions of viable tumor cells to tumor-associated lymphocytes were associated with responsiveness to treatment. It is expected that larger prospective clinical studies will further validate these findings.
帕博利珠单抗作为一种广泛应用的免疫检查点抑制剂，已彻底改变了非小细胞肺癌的治疗格局。识别可能对帕博利珠单抗产生应答患者的独特肿瘤特征，将有助于临床决策及个体化治疗策略的制定。本回顾性研究分析了84例接受帕博利珠单抗治疗的NSCLC患者的临床资料与病理特征，探讨了免疫治疗前获取的临床人口学特征与肿瘤组织病理学特征之间的关联性。治疗反应通过实体瘤疗效评价标准进行评估，根据RECIST标准将患者分为三组进行临床数据和癌组织特征的比较：应答组（包含完全缓解与部分缓解患者）、疾病稳定组和疾病进展组。结果显示，应答组患者的总生存率显著高于疾病稳定组和疾病进展组。此外，应答组与疾病稳定组的治疗前活肿瘤细胞占比显著更高，同时细胞外基质比例显著低于疾病进展组。应答组的肿瘤浸润淋巴细胞数量显著高于疾病进展组。而肿瘤坏死情况、基质构成、PD-L1表达水平（TPS 1-49%对比≥50%）与治疗反应之间均未发现显著差异。结论表明，对帕博利珠单抗治疗产生积极应答的NSCLC患者较疾病稳定或进展患者具有更好的预后，且活肿瘤细胞与肿瘤相关淋巴细胞的相对比例与治疗反应性相关。期待未来更大规模的前瞻性临床研究进一步验证这些发现。
肿瘤(癌症)患者之家