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 ,