Clinical outcomes and predictive factors of immunotherapy efficacy in non-small-cell lung cancer brain metastases: a comparative study

作者：Yuxi Wei, Rongzhen Li, Xiaoyan Liu, Yuequan Shi, Yan Xu, Jing Zhao, Minjiang Chen, Mengzhao Wang · 发表于：BMC Cancer · 年份：2025 · DOI：10.1186/s12885-025-15327-x · 被引用次数：1 · 研究领域：Brain Metastases and Treatment、Lung Cancer Research Studies、Cancer Immunotherapy and Biomarkers

BACKGROUND: Brain metastases (BMs) are common in patients with non-small-cell lung cancer (NSCLC) and remain a major therapeutic challenge. While immune checkpoint inhibitors (ICIs) have improved systemic outcomes, their intracranial efficacy and prognostic determinants in patients with BMs, particularly in comparison with chemotherapy, remains insufficiently characterized. METHODS: We conducted a multicenter, retrospective cohort study including NSCLC patients with BMs who received ICIs or chemotherapy alone. Propensity score matching was performed to balance baseline characteristics between treatment groups. Intracranial and extracranial responses, intracranial progression-free survival (iPFS), extracranial PFS (ePFS), and overall survival (OS) were compared. Logistic regression and Cox proportional hazards models were used to identify prognostic factors associated with treatment response and survival. RESULTS: In the matched cohort, patients treated with immunotherapy achieved significantly longer median OS than those receiving chemotherapy (18.9 vs. 13.3 months, p = 0.001), while intracranial and extracranial PFS were not significantly prolonged (median iPFS: 10.4 vs. 9.6 months, p = 0.09; median ePFS: 7.8 vs. 7.1 months, p = 0.06). In the intracranial efficacy–evaluable cohort, the intracranial objective response rate (iORR) was 38.9% vs. 35.2% (p = 0.759), whereas the extracranial objective response rate (eORR) was 45.9% vs. 18.0% (p = 0.006), favoring immunotherapy. Co...