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中国癌症防治杂志

中国癌症防治杂志 ›› 2025, Vol. 17 ›› Issue (6): 697-704.doi: 10.3969/j.issn.1674-5671.2025.06.07

• 论著 • 上一篇    下一篇

BAI/BACE联合铂类双药化疗及PD⁃1抑制剂治疗Ⅳ期驱动基因阴性非小细胞肺癌的临床疗效和安全性

  

  1. 成都市第六人民医院肿瘤科
  • 出版日期:2025-12-25 发布日期:2026-02-02
  • 通讯作者: 叶斌 E?mail：354539616@qq.com
  • 基金资助:
    成都市医学科研课题（2022177）

Clinical efficacy and safety of BAI/BACE combined with platinum⁃based dual⁃drug chemotherapy and PD⁃1 inhibitor in stage Ⅳ driver gene⁃negative non⁃small cell lung cancer

  • Online:2025-12-25 Published:2026-02-02

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摘要： 目的 探讨支气管动脉灌注术（bronchial arterial infusion，BAI）和支气管动脉化疗栓塞术（bronchial arterial chemoembolization，BACE）联合铂类双药化疗及PD⁃1抑制剂作为Ⅳ期驱动基因阴性非小细胞肺癌（non⁃small cell lung cancer，NSCLC）一线治疗方案的临床疗效。方法 分析成都市第六人民医院2020年4月至2024年10月收治的91例Ⅳ期驱动基因阴性NSCLC患者的临床资料。根据治疗方式将患者分为两组，BAI组（n=47）接受BAI/BACE联合铂类双药化疗及PD⁃1抑制剂治疗，非BAI组（n=44）仅接受铂类双药化疗及PD⁃1抑制剂治疗。比较两组的近期疗效、无进展生存期（progression⁃free survival，PFS）、总生存期（overall survival,OS）、治疗结束后90 d内≥1级不良事件发生率。结果 BAI组的客观缓解率高于非BAI组（68.1% vs 47.7%，P=0.049），PFS（P=0.021）与OS（P=0.012）均较非BAI组延长，中位PFS为12个月 vs 8个月，中位OS为18个月 vs 11个月。Two⁃stage分析结果显示，在早期阶段（≤12个月），BAI组的PFS和OS 均显著优于非BAI组（均P=0.003）。对BAI组进行亚组分析发现，中央型患者的PFS和OS有优于周围型患者的趋势（中位PFS：15个月vs 11个月；中位OS：21个月vs 16个月），且晚期阶段（>12个月）中央型患者的PFS（P=0.022）和OS（P=0.037）显著优于周围型患者（中位PFS：7个月vs 2个月；中位OS：14个月vs 6个月）。多因素Cox比例风险回归分析结果显示，BAI/BACE联合铂类双药化疗及PD⁃1抑制剂治疗是PFS和OS的独立保护因素（均P<0.05）。两组不良反应均以Ⅰ~Ⅱ级为主，发生率无显著差异。结论 BAI/BACE联合铂类双药化疗及PD⁃1抑制剂在Ⅳ期驱动基因阴性NSCLC患者的一线治疗中展现出良好的疗效和可控的安全性，为患者带来了明显的生存获益。

关键词: 非小细胞肺癌, 支气管动脉灌注术, 支气管动脉化疗栓塞术, 免疫治疗, 化疗

Abstract: Objective To investigate the clinical efficacy of bronchial arterial infusion (BAI) / bronchial arterial chemoembolization (BACE) combined with platinum⁃based dual⁃drug chemotherapy and PD⁃1 inhibitor as first⁃line treatment for stage Ⅳ driver gene⁃negative non⁃small cell lung cancer (NSCLC). Methods Clinical data of 91 patients with stage Ⅳ driver gene⁃negative NSCLC treated at the Chengdu Sixth People's Hospital between April 2020 and October 2024 were analyzed. Patients were categorized into two cohorts based on their treatment regimen: the BAI group (n=47) received BAI/BACE combined with platinum⁃based dual⁃drug chemotherapy and PD⁃1 inhibitor, and the non⁃BAI group (n=44) received platinum⁃based dual⁃drug chemotherapy and PD⁃1 inhibitor alone. Short⁃term efficacy, progression⁃free survival (PFS), overall survival (OS), and the incidence of adverse events (≥grade 1) within 90 days post⁃treatment were compared between the two groups. Results The objective response rate was significantly higher in the BAI group than in the non⁃BAI group (68.1% vs 47.7%, P=0.049). Additionally, the BAI group showed significantly better PFS （P=0.021）and OS （P=0.012）, with median PFS of 12 months vs 8 months and median OS of 18 months vs 11 months. Two⁃stage analysis revealed that during the early stage (≤12 months), the BAI group demonstrated significantly superior PFS and OS compared to the non⁃BAI group (all P=0.003). Subgroup analysis of the BAI group showed a trend toward better PFS and OS in patients with central⁃type tumors compared to those with peripheral⁃type tumors (median PFS: 15 months vs 11 months; median OS: 21 months vs 16 months). Furthermore, in the advanced stage (>12 months), patients with central⁃type tumors demonstrated significantly better PFS (P=0.022) and OS (P=0.037) than those with peripheral⁃type tumors (median PFS: 7 months vs 2 months; median OS: 14 months vs 6 months). Multivariate Cox proportional hazards regression analysis confirmed that treatment with BAI/BACE combined with platinum⁃based dual⁃drug chemotherapy and PD⁃1 inhibitor was an independent protective factor for both PFS and OS (all P<0.05). Adverse reactions in both groups were predominantly grade Ⅰ-Ⅱ, with no significant difference in incidence rates. Conclusions BAI/BACE combined with platinum⁃based dual⁃drug chemotherapy and PD⁃1 inhibitor demonstrated favorable efficacy and manageable safety in first⁃line treatment for stage Ⅳ driver gene⁃negative NSCLC patients, delivering significant survival benefits.

Key words:  , R734.2 ,

中图分类号: 

  • Non?small cell lung cancer