Abstract

Background and purpose

We report outcomes following spine stereotactic body radiotherapy (SBRT) in metastatic non-small cell lung cancer (NSCLC) and the significance of programmed death-ligand 1 (PD-L1) status, epidermal growth factor receptor (EGFR) mutation and timing of immune check point inhibitors (ICI) on local failure (LF).

Materials and methods

165 patients and 389 spinal segments were retrospectively reviewed from 2009 to 2021. Baseline patient characteristics, treatment and outcomes were abstracted. Primary endpoint was LF and secondary, overall survival (OS) and vertebral compression fracture (VCF). Multivariable analysis (MVA) evaluated factors predictive of LF and VCF.

Results

The median follow-up and OS were: 13.0 months (range, 0.5–95.3 months) and 18.4 months (95% CI 11.4–24.6). 52.1% were male and 76.4% had adenocarcinoma. Of the 389 segments, 30.3% harboured an EGFR mutation and 17.0% were PD-L1 ≥ 50%. The 24 months LF rate in PD-L1 ≥ 50% vs PD-L1 < 50% was 10.7% vs. 38.0%, and in EGFR-positive vs. negative was 18.1% vs. 30.0%. On MVA, PD-L1 status of ≥ 50% (HR 0.32, 95% CI 0.15–0.69, p = 0.004) significantly predicted for lower LF compared to PD-L1 < 50%. Lower LF trend was seen with ICI administration peri and post SBRT (HR 0.41, 95% CI 0.16–1.05, p = 0.062). On MVA, polymetastatic disease (HR 3.28, 95% CI 1.84–5.85, p < 0.0001) and ECOG ≥ 2 (HR 1.87, 95% CI 1.16–3.02, p = 0.011) significantly predicted for worse OS and absence of baseline VCF predicted for lower VCF rate (HR 0.20, 95% CI 0.10–0.39, p < 0.0001).

Conclusion

We report a significant association of PD-L1 ≥ 50% status on improved LC rates from spine SBRT in NSCLC patients.

中文翻译：

---

分子标记在预测立体定向放射治疗肺癌脊柱转移局部控制中的应用

摘要

背景和目的

我们报告了转移性非小细胞肺癌 (NSCLC) 脊柱立体定向放射治疗 (SBRT) 后的结果以及程序性死亡配体 1 (PD-L1) 状态、表皮生长因子受体 (EGFR) 突变和免疫时机的重要性。局部故障（LF）的检查点抑制剂（ICI）。

材料和方法

对 2009 年至 2021 年期间的 165 名患者和 389 个脊柱节段进行了回顾性分析。提取了患者的基线特征、治疗和结果。主要终点是 LF，次要终点是总生存期 (OS) 和椎体压缩性骨折 (VCF)。多变量分析 (MVA) 评估了 LF 和 VCF 的预测因素。

结果

中位随访时间和 OS 分别为：13.0 个月（范围，0.5-95.3 个月）和 18.4 个月（95% CI 11.4-24.6）。 52.1% 为男性，76.4% 患有腺癌。在 389 个片段中，30.3% 存在 EGFR 突变，17.0% 为 PD-L1 ≥ 50%。 PD-L1 ≥ 50% 与 PD-L1 < 50% 的 24 个月 LF 率分别为 10.7% 和 38.0%，EGFR 阳性与阴性的 24 个月 LF 率分别为 18.1% 和 30.0%。在 MVA 中，与 PD-L1 < 50% 相比，PD-L1 状态≥ 50%（HR 0.32，95% CI 0.15–0.69，p  = 0.004）可显着预测较低的 LF。 SBRT 期间和之后 ICI 给药可观察到较低的 LF 趋势（HR 0.41，95% CI 0.16–1.05，p  = 0.062）。在 MVA 上，多转移性疾病（HR 3.28，95% CI 1.84–5.85，p  < 0.0001）和 ECOG ≥ 2（HR 1.87，95% CI 1.16–3.02，p  = 0.011）显着预测 OS 会更差，并且不存在预测的基线 VCF对于较低的 VCF 率（HR 0.20，95% CI 0.10–0.39，p  < 0.0001）。

结论

我们报告了 NSCLC 患者中 PD-L1 ≥ 50% 状态与脊柱 SBRT 改善的 LC 率存在显着相关性。