Purpose: To investigate IMT use and survival in real-world stage IVB cervical cancer patients outside randomized clinical trials. Methods: Patients diagnosed with stage IVB cervical cancer during 2013–2019 in the National Cancer Database and treated with chemotherapy (CT) ± external beam radiation (EBRT) ± intracavitary brachytherapy (ICBT) ± IMT were studied. The adjusted hazard ratio (AHR) and 95% confidence interval (CI) for risk of death were estimated in patients treated with vs. without IMT after applying propensity score analysis to balance the clinical covariates. Results: There were 3164 evaluable patients, including 969 (31%) who were treated with IMT. The use of IMT increased from 11% in 2013 to 46% in 2019. Age, insurance, facility type, sites of distant metastasis, and type of first-line treatment were independently associated with using IMT. In propensity-score-balanced patients, the median survival was 18.6 vs. 13.1 months for with vs. without IMT (p< 0.001). The AHR was 0.72 (95% CI = 0.64–0.80) for adding IMT overall, 0.72 for IMT + CT, 0.66 for IMT + CT + EBRT, and 0.69 for IMT + CT + EBRT + ICBT. IMT-associated survival improvements were suggested in all subgroups by age, race/ethnicity, comorbidity score, facility type, tumor grade, tumor size, and site of metastasis. Conclusions: IMT was associated with a consistent survival benefit in real-world patients with stage IVB cervical cancer.
目的：旨在探究随机临床试验之外的真实世界IVB期宫颈癌患者中免疫治疗（IMT）的应用及其生存获益情况。方法：本研究纳入美国国家癌症数据库中2013年至2019年诊断为IVB期宫颈癌并接受化疗（CT）±外照射放疗（EBRT）±腔内近距离放疗（ICBT）±IMT治疗的患者。通过倾向性评分分析平衡临床协变量后，比较接受与未接受IMT治疗患者的死亡风险，计算调整后风险比（AHR）及其95%置信区间（CI）。结果：共纳入3164例可评估患者，其中969例（31%）接受了IMT治疗。IMT使用率从2013年的11%上升至2019年的46%。年龄、保险类型、医疗机构性质、远处转移部位及一线治疗方案类型与IMT使用独立相关。在倾向性评分平衡后的患者中，接受与未接受IMT治疗患者的中位生存期分别为18.6个月和13.1个月（p<0.001）。总体加入IMT治疗的AHR为0.72（95% CI=0.64-0.80），其中IMT+CT方案为0.72，IMT+CT+EBRT方案为0.66，IMT+CT+EBRT+ICBT方案为0.69。按年龄、种族/民族、合并症评分、医疗机构类型、肿瘤分级、肿瘤大小及转移部位划分的所有亚组均提示IMT可改善生存。结论：在真实世界IVB期宫颈癌患者中，IMT治疗与持续稳定的生存获益相关。
肿瘤(癌症)患者之家