ArticleRadiation oncology (London, England)2025
Locally advanced non-small cell lung cancer with negative or low programmed death ligand 1 expression: a prognostic factor analysis of real-world data after the PACIFIC trial.
Article in Radiation oncology (London, England), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundReal-world data on patients with locally advanced non-small cell lung cancer (LA-NSCLC) treated with chemoradiotherapy have been reported; however, prognostic factors in patients with negative or low programmed cell death ligand 1 (PD-L1) expression are unclear. Therefore, we aimed to explore prognostic factors in patients with LA-NSCLC with negative or low PD-L1 expression using real-world data obtained after the PACIFIC trial.
methodsPatients with LA-NSCLC with negative or low PD-L1 expression who received definitive radiotherapy at our institution between March 2017 and May 2022 were included. Competing risk analyses were used to evaluate cumulative incidence of cancer-specific death (CI-CSD), cumulative incidence of recurrence (CI-R), cumulative incidence of distant metastasis (CI-DM), and cumulative incidence of in-field recurrence (CI-IFR).
resultsThe study included the data of 130 patients. Median follow-up was 37 (range, 2–72) months after radiotherapy initiation; 54 (41.5%) patients died, among whom 49 died of lung cancer, and 75 (57.7%) received durvalumab. Multivariate analyses revealed that interstitial lung abnormality (ILA) score ≥ 1 was a significant factor of shorter OS and higher CI-IFR, and a mean heart dose ≥ 7.5 Gy showed a trend toward significance for shorter OS., Internal high-dose volumetric modulated arc therapy was associated with lower CI-R, whereas poor baseline performance status correlated with higher CI-DM. Notably, durvalumab administration was marginally associated with lower CI-R.
conclusionsPre-treatment ILA and high mean heart doses negatively impacted OS in patients with LA-NSCLC with negative or low PD-L1 expression according to real-world data obtained after the PACIFIC trial.
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