Background: Extensive-stage small cell lung cancer (ES-SCLC) is a malignant tumor with remarkable proliferative and invasive ability, which has very poor clinical prognosis due to lack of effective treatments. This study aims to evaluate the efficacy and synergistic effects of radiotherapy (RT) combined with immunotherapy (IT) and chemotherapy (CT) in patients with ES-SCLC.
Methods: A retrospective analysis was performed on 145 ES-SCLC patients treated with first-line CT. Kaplan-Meier analysis and Log-rank tests were used to evaluate survival outcomes, while propensity score matching (PSM) was applied to reduce confounding factors.
Results: The median overall survival (mOS) and median progression-free survival (mPFS) for the entire cohort were 15.7 and 6.9 mon, respectively. The IT+CT group had a significantly longer mOS compared to the CT group (17.2 vs 13.5 mon, P=0.047). Similarly, the RT+CT group demonstrated superior mOS (18.5 vs 12.3 mon, P<0.001) and mPFS (7.1 vs 6.2 mon, P=0.006) compared to the CT group. Multivariate analysis identified RT, IT, and Eastern Cooperative Oncology Group performance status (ECOG PS) as independent prognostic factors for mOS (P<0.05), while gender and ECOG PS were independent predictors for mPFS (P<0.05). Following PSM, the RT+CT group continued to exhibit significant advantages in mOS (18.0 vs 12.1 mon, P<0.001) and mPFS (7.1 vs 5.5 mon, P=0.037) compared to the CT group. Notably, the RT+IT+CT group achieved a markedly longer mOS than the IT+CT group (28.5 vs 15.8 mon, P=0.017). Grade 3-4 adverse events occurred in 27.6% of patients, with no grade 5 adverse events reported.
Conclusions: The combination of RT, IT, and CT significantly enhances the prognosis of ES-SCLC patients. RT plays a key role in their synergistic effects and demonstrates good safety, warranting further research and clinical application.
【中文题目：放疗联合免疫治疗和化疗改善 广泛期小细胞肺癌预后并展现协同作用】 【中文摘要：背景与目的 广泛期小细胞肺癌（extensive-stage small cell lung cancer, ES-SCLC）是一种具有极强增殖和侵袭能力的恶性肿瘤。由于缺乏有效的综合治疗手段，ES-SCLC患者的临床预后较差。本研究旨在探讨放疗（radiotherapy, RT）联合免疫治疗（immunotherapy, IT）及化疗（chemotherapy, CT）对ES-SCLC患者的疗效及其协同作用。方法 回顾性分析145例接受一线CT治疗的ES-SCLC患者，采用Kaplan-Meier法和Log-rank检验进行生存分析，并通过倾向性评分匹配（propensity score matching, PSM）减少干扰因素。结果 所有患者的中位总生存期（median overall survival, mOS）和中位无进展生存期（median progression-free survival, mPFS）分别为15.7和6.9个月。IT+CT组较CT组的mOS显著延长（17.2 vs 13.5个月，P=0.047），RT+CT组的mOS（18.5 vs 12.3个月，P<0.001）和mPFS（7.1 vs 6.2个月，P=0.006）较CT组均显著改善。多因素分析显示，RT、IT及东部肿瘤协作组体能状态（Eastern Cooperative Oncology Group performance status, ECOG PS）评分是mOS的独立预测因素（P<0.05），性别及ECOG PS评分是mPFS的独立预测因素（P<0.05）。PSM后，RT+CT组的mOS（18.0 vs 12.1个月，P<0.001）和mPFS（7.1 vs 5.5个月，P=0.037）仍显著优于CT组。RT+IT+CT组的mOS较IT+CT组进一步延长（28.5 vs 15.8个月，P=0.017）。3-4级不良事件发生率为27.6%，未见5级不良事件。结论 RT联合IT及CT可显著改善ES-SCLC患者预后，且RT在协同作用中发挥关键作用，安全性良好，值得进一步研究与临床应用。 】 【中文关键词：肺肿瘤；免疫治疗；放疗；协同效应】.
Keywords: Immunotherapy; Lung neoplasms; Radiotherapy; Synergistic effect.