Efficacy and safety of first-line systemic therapy combined with local intensive therapy for stage Ⅳ lung adenocarcinoma

JIA Yangyang; MAO Yunye; LIN Liyan; WANG Jinliang

doi:10.3969/j.issn.1674-3806.2024.12.04

Abstract：Objective To explore the efficacy and safety of first-line systemic therapy combined with local intensive therapy for stage Ⅳ lung adenocarcinoma patients.Methods The clinical data of 152 patients with stage Ⅳ lung adenocarcinoma who were admitted to Chinese PLA General Hospital from January 2022 to June 2023 were retrospectively analyzed.Seventy-four patients who received first-line systemic therapy combined with local intensive therapy were enrolled as group A,and 78 patients who received first-line systemic therapy alone were enrolled as group B.The primary endpoints were progression-free survival(PFS),and the secondary endpoints were overall survival(OS)and treatment-related adverse events.Results The median follow-up time was 30.1 months,and the median PFS of the overall population was 28.0 months,of which the median PFS of the group A was 42.0 months,and the median PFS of the group A was significantly higher than that of the group B(20.7 months),and the difference was statistically significant(P＜0.05).The results of multivariate Cox regression analysis showed that female and local intensive therapy were protective factors for better prognosis of PFS in the patients(P＜0.05),while lymph node metastases(N stages of N1,N2 and N3)were risk factors for poor prognosis of PFS(P＜0.05),and smoking history and lymph node metastases(N stages of N1,N2 and N3)were risk factors for poor OS prognosis(P＜0.05),and chemotherapy combined with immunotherapy was a risk factor for poor OS prognosis(P＜0.05).Conclusion First-line systemic therapy combined with local intensive therapy can significantly improve PFS in patients with stage Ⅳ lung adenocarcinoma,in which radiotherapy and ablative therapy play a key role.The adverse events associated with the combination therapy are generally controllable.