摘要:
Purpose/Objective(s) The role of radiotherapy, in addition to chemotherapy, has not been thoroughly determined in metastatic non-small cell lung cancer (mNSCLC). The purpose of the study was to investigate clinical characterization and treatment-related parameter of long-term survival in mNSCLC patients treated with concurrent chemotherapy with thoracic radiation therapy. In our previous study, the count of CD4-positive and CD8-positive T cells was associated with overall survival (OS). We speculated that baseline lung immune prognostic index (LIPI) based on pretreatment neutrophils/(leukocytes minus neutrophils) ratio (dNLR) and lactate dehydrogenase (LDH) level may be associated with OS. Thus, the prognostic value of LIPI level was also evaluated in this study. Materials/Methods We retrospectively analyzed 243 eligible patients with mNSCLC who were treated with chemotherapy and concurrent radiation to the primary tumor in two prospective studies. These patients had received at least two chemotherapy cycles and a thoracic radiation dose of at least 40 Gy in 2-Gy fractions, and did not receive targeted therapy or immunotherapy during lifetime. According to previous publications, dNLR greater than 3 and LDH greater than upper limit of normal was developed, characterizing 3 groups (good, 0 factors; intermediate, 1 factor; poor, 2 factors). Prognostic factors for OS were identified by using univariate and multivariate analysis. Propensity-score matching (PSM) were performed to further adjust for confounding. OS≥ 18 months was defined as long-term survival (LTS). Results According to LIPI, 141 patients were classified into good group, 83 patients in intermediate, and 19 patients in poor group. The number of patients was small in poor group. Thus, intermediate group and poor group were merged into the same risk group (intermediate-poor group). A total of 78 patients with long-term survival, 57 (40.4%) patients in good group, and 21 (20.6%) patients in intermediate-poor g