The Effect of Pleural Effusion on Prognosis in Patients with Non-Small Cell Lung Cancer Undergoing Immunochemotherapy: A Retrospective Observational Study

Tomoka Nishimura, Eiki Ichihara, Toshihide Yokoyama, Koji Inoue, Tomoki Tamura, Ken Sato, Naohiro Oda, Hirohisa Kano, Daizo Kishino, Haruyuki Kawai, Masaaki Inoue, Nobuaki Ochi, Nobukazu Fujimoto, Hirohisa Ichikawa, Chihiro Ando, Katsuyuki Hotta, Yoshinobu Maeda, Katsuyuki Kiura

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: Combined immune checkpoint inhibitor (ICI) therapy and chemotherapy has become the standard treatment for advanced non-small-cell lung cancer (NSCLC). Pleural effusion (PE) is associated with poor outcomes among patients with NSCLC undergoing chemotherapy. However, minimal data exists on PE for patients undergoing combined ICI and chemotherapy. Therefore, we investigated how PE affects survival outcomes in patients with NSCLC undergoing this combined therapy. Methods: We identified patients with advanced NSCLC undergoing chemotherapy and ICI therapy from the Okayama Lung Cancer Study Group–Immune Chemotherapy Database (OLCSG–ICD) between December 2018 and December 2020; the OLCSG–ICD includes the clinical data of patients with advanced NSCLC from 13 institutions. Then, we analyzed the treatment outcomes based on the presence of PE. Results: We identified 478 patients who underwent combined ICI therapy and chemotherapy; 357 patients did not have PE, and 121 patients did have PE. Patients with PE had significantly shorter progression-free survival (PFS) and overall survival (OS) than those without PE (median PFS: 6.2 months versus 9.1 months; p < 0.001; median OS: 16.4 months versus 27.7 months; p < 0.001). The negative effect of PE differed based on the patient’s programmed cell death-ligand 1 (PD-L1) expression status; with the effect being more evident in patients with high PD-L1 expression. In addition, PFS and OS did not differ between patients who did and did not undergo bevacizumab treatment; thus, bevacizumab-containing regimens did not improve the survival outcomes for patients with PE. Conclusion: PE is associated with poor outcomes among patients with NSCLC undergoing combined ICI therapy and chemotherapy.

Original languageEnglish
Article number6184
JournalCancers
Volume14
Issue number24
DOIs
Publication statusPublished - Dec 2022

Keywords

  • immune checkpoint inhibitors
  • non-small cell carcinoma
  • pleural effusion

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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