晚期非小细胞肺癌患者接受免疫治疗后年龄与生存趋势的关系

SCI 14 February 2023

Association Between Age and Survival Trends in Advanced Non–Small Cell Lung Cancer After Adoption of Immunotherapy

（JAMA Oncology；IF: 33.006）

Teja Voruganti; Pamela R. Soulos; Ronac Mamtani; Carolyn J. Presley; Cary P. Gross

CORRESPONDENCE TO: cary.gross@yale.edu

IMPORTANCE 重要性  

The introduction of immune checkpoint inhibitors (ICIs) has transformed the care of advanced non–small cell lung cancer (NSCLC). Although clinical trials suggest substantial survival benefits, it is unclear how outcomes have changed in clinical practice.

免疫检查点抑制剂（ICI）的引入改变了晚期非小细胞肺癌（NSCLC）的治疗。尽管临床试验显示了显著的生存益处，但尚不清楚结果是如何改变的。

OBJECTIVE 目的  

To assess temporal trends in ICI use and survival among patients with advanced NSCLC across age strata.

评估不同年龄层晚期NSCLC患者ICI使用和生存的时间趋势。

DESIGN, SETTING, AND PARTICIPANTS 试验设计

This cohort study was performed in approximately 280 predominantly community-based US cancer clinics and included patients aged 18 years or older who had stage IIIB, IIIC, or IV NSCLC diagnosed between January 1, 2011, and December 31, 2019, with follow-up through December 31, 2020. Data were analyzed April 1, 2021, to October 19, 2022.

这项队列研究在大约280家主要以社区为基础的美国癌症诊所进行，包括2011年1月1日至2019年12月31日诊断为IIIB、IIIC或IV期非小细胞肺癌的18岁及以上患者，随访至2020年12月30日。数据分析于2021年4月1日至2022年10月19日。

MAIN OUTCOMES AND MEASURES 研究指标和研究方法  

Median overall survival and 2-year survival probability. The predicted probability of 2-year survival was calculated using a mixed-effects logit model adjusting for demographic and clinical characteristics.

中位总生存率和2年生存率。使用混合效应逻辑回归模型预测2年生存率，并根据人口统计学和临床特征进行调整。

RESULTS 结果  

The study sample included 53 719 patients (mean [SD] age, 68.5 [9.3] years; 28 374 men [52.8%]), the majority of whom were White individuals (36 316 [67.6%]). The overall receipt of cancer-directed therapy increased from 69.0% in 2011 to 77.2% in 2019. After the first US Food and Drug Administration approval of an ICI for NSCLC, the use of ICIs increased from 4.7% in 2015 to 45.6% in 2019 (P < .001). Use of ICIs in 2019 was similar between the youngest and oldest patients (aged <55 years, 45.2% vs aged ≥75 years, 43.8%; P = .59). From 2011 to 2018, the predicted probability of 2-year survival increased from 37.7% to 50.3% among patients younger than 55 years and from 30.6% to 36.2% in patients 75 years or older (P < .001). Similarly, median survival in patients younger than 55 years increased from 11.5 months to 16.0 months during the study period, while survival among patients 75 years or older increased from 9.1 months in 2011 to 10.2 months in 2019.

研究样本包括53719名患者（平均年龄68.5[9.3]岁；28374名男性[52.8%]），其中大多数为白人（36316[67.6%]）。接受癌症靶向治疗的总人数从2011年的69.0%增加到2019年的77.2%。FDA首次批准用于NSCLC的ICI后，ICI的使用率从2015年的4.7%增加到2019年的45.6%（P<0.001）。2019年年龄最小和年龄最大的患者ICI的使用率类似（年龄<55岁，45.2%与年龄≥75岁，43.8%；P=.59）。从2011年到2018年，55岁以下患者的2年生存率预测值从37.7%增加到50.3%，75岁或以上患者的预测值从30.6%增加到36.2%（P<0.001）。同样，55岁以上患者的中位生存率在研究期间从11.5个月增加到16.0个月，而75岁或以上患者的生存期从2011年的9.1个月增加到2019年的10.2个月。

CONCLUSIONS AND RELEVANCE 结论  

This cohort study found that, among patients with advanced NSCLC, the uptake of ICIs after US Food and Drug Administration approval was rapid across all age groups. However, corresponding survival gains were modest, particularly in the oldest patients.

队列研究发现在晚期NSCLC患者中，所有年龄组的经FDA批准的ICI摄入都很快。然而，相应的生存率增长是有限的，尤其是在年龄最大的患者中。