Abstract:
Background It has been reported that comorbidities may be associated with survival and prognosis of patients with non-small cell lung cancer (NSCLC), but few studies have evaluated the relationship between comorbidities and immunotherapy.
Objective To assess the association between the age-adjusted Charlson Comorbidity Index (aCCI) and the clinical prognosis outcomes of elderly patients with advanced NSCLC treated with anti-PD-1 immune checkpoint inhibitors.
Methods Clinical data about patients aged 70 years or older with NSCLC diagnosed as ⅢA to ⅣB who were admitted to the First Medical Center of Chinese PLA General Hospital and treated with anti-PD-1 immunotherapy from January 1, 2014 to December 31, 2019 were retrospectively analyzed. The relationship between different clinical characteristics and prognosis were analyzed using univariate and multivariate Cox regression analyses, and the impact of different factors on patients' survival was analyzed using Kaplan-Meier survival curves.
Results A total of 118 patients were enrolled, with 94 males and a mean age of 74.7 years old. The median progression-free survival (PFS) was 10.6 months (95% CI, 6.0-15.2) in the low aCCI score group (＜9 points) and 6.1 months (95% CI, 4.8-7.4) in the high aCCI score group (≥9 points); the median overall survival (OS) was 33.9 months (95% CI, 13.7-54.1) in the low aCCI score group and 11.7 months (95% CI, 9.5-13.9) in the high aCCI score group, and the survival prognosis indicators (PFS and OS) in the low aCCI score group were superior to those in the high aCCI score group (P＜0.01, respectively). Cox regression analysis suggested that Eastern Cooperative Oncology Group performance status (ECOG PS ) and aCCI were associated with the prognosis of the elderly NSCLC patients.
Conclusion Comorbidity burden assessed by aCCI can predict the prognosis of elderly patients with advanced NSCLC treated with anti-PD1 immunotherapy, but further large-scale prospective studies are needed to validate this.
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