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Background <p>Real-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.</p> Methods <p>Patients 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).</p> Results <p>The 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&#xa0;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.</p> Conclusions <p>Pre-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.</p>

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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

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月16日

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  • Tairo Kashihara,
  • Yuko Nakayama,
  • Kae Okuma,
  • Ayaka Nagao,
  • Kana Takahashi,
  • Tomoya Kaneda,
  • Yuko Kubo,
  • Kimiteru Ito,
  • Satoshi Nakamura,
  • Hiroyuki Okamoto,
  • Yasushi Yatabe,
  • Masahiko Kusumoto,
  • Yuichiro Ohe,
  • Hiroshi Igaki

摘要

Background

Real-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.

Methods

Patients 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).

Results

The 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.

Conclusions

Pre-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.