肿瘤药学2025，Vol.15Issue(5)：618-629,12.DOI:10.3969/j.issn.2095-1264.2025.05.07
非小细胞肺癌不同进展模式的临床特征与治疗结局分析
Clinical characteristics and treatment outcomes analysis of different progression patterns in non-small cell lung cancer
摘要
Abstract
Objective To investigate the impact of progression patterns(oligoprogression vs.systemic progression)and resistance types(primary vs.acquired)on survival outcomes in patients with advanced non-small cell lung cancer(NSCLC)following first-line immunotherapy combined with chemotherapy,and to explore their associations with biomarkers such as PD-L1.Methods A total of 579 patients with advanced NSCLC who experienced disease progression after first-line immu-no-chemotherapy at Hunan Cancer Hospital between April 2018 and October 2022 were retrospectively enrolled.Patients were stratified by progression pattern into oligoprogression and systemic progression groups,and further subcategorized by resistance type.Propensity score matching(PSM)was used to balance baseline characteristics between groups and mini-mize confounding.Overall survival(OS)and progression-free survival(PFS)were analyzed using the Kaplan-Meier method and compared with the log-rank test.Binary logistic regression was used to identify factors associated with progression pat-terns.Tumor response was assessed per RECIST v1.1.Results Multivariate logistic regression identified male sex,smoking history,and squamous cell carcinoma histology as independent factors associated with a higher likelihood of oligoprogres-sion.PD-L1 expression levels did not differ significantly between the two progression groups(P＞0.05).Progression patterns demonstrated a time-dependent dynamic:systemic progression was more common early in treatment,while the proportion of oligoprogression increased among long-term survivors.The oligoprogression group had significantly longer median PFS and OS than the systemic progression group.Further analysis by resistance type revealed that patients with acquired resis-tance had significantly longer median PFS and OS than those with primary resistance,a trend consistent within both progres-sion patterns.The objective response rate was significantly higher in the oligoprogression group(P＜0.000 1).Conclusion Pa-tients exhibiting oligoprogression,particularly those with acquired resistance,derive significant survival benefit,whereas those with primary resistance have a poorer prognosis.Treatment strategies should be dynamically adjusted based on pro-gression patterns and resistance types to achieve personalized management.关键词
非小细胞肺癌/免疫检查点抑制剂/寡进展/原发性耐药/PD-L1Key words
Non-small cell lung cancer/Immune checkpoint inhibitors/Oligoprogression/Primary drug resistance/PD-L1分类
医药卫生引用本文复制引用
HUANG Jiao,ZHANG Aogui,ZHANG Yongchang,ZENG Liang,XU Qinqin..非小细胞肺癌不同进展模式的临床特征与治疗结局分析[J].肿瘤药学,2025,15(5):618-629,12.基金项目
青海省科技计划项目(2022-ZJ-733). （2022-ZJ-733）
