Therapeutic Advances in Medical Oncology (Aug 2024)

Pretreatment pulmonary tumor necrosis is a promising prognostic imaging biomarker for first-line anti-PD-1/PD-L1 therapy in advanced lung squamous cell carcinoma: a multi-institutional, propensity score-matching cohort analysis

  • Qiaofeng Zhong,
  • Longfeng Zhang,
  • Lin Wu,
  • Jun Zhao,
  • Jianguo Sun,
  • Yong Fang,
  • Jin Zhou,
  • Qian Chu,
  • Yihong Shen,
  • Zhenzhou Yang,
  • Lijin Chen,
  • Meijuan Huang,
  • Xiaoyan Lin,
  • Zhenhua Liu,
  • Peng Shen,
  • Zhijie Wang,
  • Xin Wang,
  • Huijuan Wang,
  • Chengbo Han,
  • Anwen Liu,
  • Hongmei Zhang,
  • Feng Ye,
  • Wen Gao,
  • Fang Wu,
  • Zhengbo Song,
  • Shengchi Chen,
  • Chengzhi Zhou,
  • Dingzhi Huang,
  • Qiuyu Zhang,
  • Xinlong Zheng,
  • Xiaobin Zheng,
  • Qian Miao,
  • Kan Jiang,
  • Zihua Zou,
  • Yiquan Xu,
  • Shiwen Wu,
  • Haibo Wang,
  • Yaping Hong,
  • Tao Lu,
  • Chao Li,
  • Cheng Huang,
  • Chuanben Chen,
  • Gen Lin

DOI
https://doi.org/10.1177/17588359241266188
Journal volume & issue
Vol. 16

Abstract

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Background: Tumor necrosis (TN) is a common feature in lung squamous cell carcinoma (LSCC), which could provide useful predictive and prognostic information. Objectives: This study aimed to investigate the effect of pretreatment pulmonary TN (PTN) on the prognosis of first-line anti-programmed cell death 1 (PD-1)/PD ligand 1 (PD-L1) inhibitor in advanced LSCC. Design: We conducted a retrospective study to analyze the association between the presence of PTN and clinical outcomes in advanced LSCC patients treated with anti-PD-1/PD-L1 inhibitors. Methods: Data from 240 eligible patients were collected from 27 hospitals across China between 2016 and 2020. The presence of PTN was assessed using contrast-enhanced chest computed tomography (CT) imaging at baseline. We utilized the Cox proportional-hazards regression model to analyze the association between PTN and clinical outcomes. In addition, to account for potential confounding factors and ensure comparability between groups, we employed propensity score-matching (PSM) analysis. Results: In the overall patient cohort, the presence of PTN was 39.6%. The median follow-up duration was 20.3 months. The positive PTN group exhibited a notably inferior median progression-free survival (PFS; 6.5 months vs 8.6 months, p = 0.012) compared to the negative PTN group. Within the Cox proportional-hazards regression model, PTN emerged as an independent predictor of unfavorable PFS (hazard ratio (HR) = 1.354, 95% confidence interval (CI): 1.002–1.830, p = 0.049). After PSM, the median PFS for the positive PTN group (6.5 months vs 8.0 months, p = 0.027) remained worse than that of the negative PTN group. Multivariate analyses also further underscored that the presence of PTN independently posed a risk for shorter PFS (HR = 1.494, 95% CI: 1.056–2.112, p = 0.023). However, no statistically significant difference in overall survival was observed between the two groups. Conclusion: Our study suggests that the presence of PTN on baseline contrast-enhanced chest CT is a potential negative prognostic imaging biomarker for the outcome of anti-PD-1/PD-L1 inhibitor therapy in advanced LSCC. Further studies are warranted to validate these findings and explore the underlying mechanisms.