免疫疗法（IO）已在治疗广泛期小细胞肺癌（ES-SCLC）方面显示出有希望的结果，广泛期小细胞肺癌脑转移（BMs）的治疗现在受到重视。本研究的目的是评估IO在BMs的临床管理中的作用。研究收集了2020年1月至2021年12月间250名被诊断为ES-SCLC的患者的记录。利用Kaplan-Meier方法计算总生存期（OS）、无进展生存期、颅内无进展生存期和BM的累积发生率，并利用对数秩检验进行比较。此外，还使用Cox回归模型分析预后因素。在整个群体中，85名患者有基线BMs（IO + 化疗组[IO + ChT]，n = 38；仅化疗组，n = 47），而165名患者（IO + 化疗组，n = 86；仅化疗组，n = 79）在初步诊断时没有BMs。中位随访时间为22.4个月。首线抗程序性死亡配体1（PD-L1）疗法的OS益处不受BMs有无的影响（有BMs，17.97 vs. 13.14个月[p = .03]；没有BMs，18.46 vs. 15.05个月[p = .047]）。然而，在没有BMs的患者中，IO并不能延迟发展脑部进展的中位时间（10.84 vs. 10.74个月；p = .84），并且不能显著降低发生颅内转移的风险（2年累积BM发生风险分别为57.0% vs. 50.6%）。抗PD-L1疗法改善了生存期，无论是否有BMs。然而，在没有基线BMs的患者中，IO不能延迟发展至脑部的中位时间，也不能减少发生颅内转移的风险。这项研究的发现对将来ES-SCLC的BMs的临床管理具有重要意义。© 2023 American Cancer Society.

Immunotherapy (IO) has demonstrated promising results in treating extensive-stage small cell lung cancer (ES-SCLC), and the management of ES-SCLC brain metastases (BMs) is now receiving significant clinical attention. The objective of this study was to evaluate the role of IO in the clinical management of BMs.Between January 2020 and December 2021, the study included the records of 250 patients who were diagnosed with ES-SCLC. Overall survival (OS), progression-free survival, intracranial progression-free survival, and the cumulative incidence of BMs were calculated using the Kaplan-Meier method and were compared using the log-rank test. In addition, the Cox regression model was used to analyze prognostic factors.In the entire group, 85 patients had baseline BMs (IO plus chemotherapy [IO + ChT], n = 38; ChT alone, n = 47), and 165 patients (IO + ChT, n = 86; ChT alone, n = 79) did not have BMs at the time of initial diagnosis. The median follow-up was 22.4 months. The OS benefit with first-line antiprogrammed death ligand 1 therapy was maintained regardless of whether patients had BMs (with BMs, 17.97 vs. 13.14 months [p = .03]; without BMs, 18.46 vs. 15.05 months [p = .047]). However, in patients without BMs, IO did not delay the median time to developing brain progression (10.84 vs. 10.74 months; p = .84), and it did not significantly reduce the risk of developing intracranial metastases (the 2-year actuarial risk of developing BMs was 57.0% vs. 50.6%, respectively).Antiprogrammed death ligand 1 therapy improved OS regardless of the presence of BMs. However, IO did not delay the median time to brain progression or reduce the risk of intracranial metastasis in patients without baseline BMs. The findings of this study have important clinical implications for the future management of BMs from ES-SCLC.© 2023 American Cancer Society.