Background/Objectives: Pembrolizumab monotherapy is approved in Canada for first-line treatment of advanced NSCLC with PD-L1 ≥ 50% and no EGFR/ALK aberrations. However, approximately 55% of these patients do not respond to pembrolizumab, underscoring the need for the early intervention of non-responders to optimize treatment strategies. Distinguishing the 55% sub-cohort prior to treatment is a real-world dilemma. Methods: In this retrospective study, we analyzed two patient cohorts treated with pembrolizumab monotherapy (training set:n= 97; test set:n= 17). The treatment response was assessed using baseline and follow-up CT scans via RECIST 1.1 criteria. Results: A logistic regression model, incorporating pre-treatment CT radiomic features of lung tumors and clinical variables, achieved high predictive accuracy (AUC: 0.85 in training; 0.81 in testing, 95% CI: 0.63–0.99). Notably, radiomic features from the peritumoral region were found to be independent predictors, complementing the standard CT evaluations and other clinical characteristics. Conclusions: This pragmatic model offers a valuable tool to guide first-line treatment decisions in NSCLC patients with high PD-L1 expression and has the potential to advance personalized oncology and improve timely disease management.
背景/目的：帕博利珠单抗单药疗法在加拿大获批用于PD-L1表达≥50%且无EGFR/ALK基因突变的晚期非小细胞肺癌一线治疗。然而，约55%的患者对该药物无应答，这凸显了对无应答者进行早期干预以优化治疗策略的必要性。如何在治疗前准确识别这55%的患者亚群是临床实践中的现实难题。方法：本回顾性研究分析了两个接受帕博利珠单抗单药治疗的患者队列（训练集：n=97；测试集：n=17）。通过RECIST 1.1标准，利用基线和随访CT扫描评估治疗反应。结果：结合肺部肿瘤治疗前CT影像组学特征与临床变量的逻辑回归模型展现出较高的预测准确性（训练集AUC：0.85；测试集AUC：0.81，95% CI：0.63–0.99）。值得注意的是，瘤周区域的影像组学特征被证实为独立预测因子，可作为标准CT评估和其他临床特征的有效补充。结论：这一实用性模型为高PD-L1表达非小细胞肺癌患者的一线治疗决策提供了有价值的指导工具，有望推动个性化肿瘤治疗发展并提升疾病管理的时效性。
肿瘤(癌症)患者之家