本研究旨在评估局部消融治疗 (LAT) 联合派姆单抗 (pembrolizumab) 对同时性寡转移性非小细胞肺癌 (NSCLC) 患者的疗效，并确定最能从 LAT 中受益的患者。 2017 年 1 月至 2022 年 12 月期间接受一线帕博利珠单抗治疗的 NSCLC（转移性病灶≤5 个且受累器官≤3 个）。接受 LAT（包括所有疾病部位的手术或放疗）的患者与未接受 LAT 的患者进行比较。使用无进展生存期 (PFS) 的预后因素开发了递归分区分析 (RPA) 模型。在纳入的 258 名患者中，78 名接受 LAT 联合派姆单抗治疗，180 名患者单独接受派姆单抗治疗。中位随访时间为 15.5 个月（范围：3.0-71.2）。在整个队列中，LAT 与显着改善的 PFS（风险比 [HR]，0.64；P=0.015）和总生存期（OS）（HR，0.61；P=0.020）独立相关。在倾向评分匹配队列（每组 N=74）中，中位 PFS 分别为 19.9 个月和 9.6 个月（P=0.003），中位 OS 分别为 42.2 个月和 20.5 个月（P=0.045） ，对于 LAT 和非 LAT 组。基于 RPA 模型，结合转移病灶数量、体能状态和 PD-L1 表达水平，将患者分为三个具有不同 PFS 的风险组。 LAT 显着改善了低风险和中风险组的 PFS 和 OS；然而，在高风险组中没有观察到差异。 LAT 作为帕博利珠单抗开始后的巩固治疗比作为前期治疗更有效。在选定的同时性寡转移 NSCLC 患者中，与单独使用帕博利珠单抗相比，LAT 联合帕博利珠单抗可带来更高的 PFS 和 OS。 RPA 模型可以作为一种有价值的临床工具，用于识别适合 LAT 的患者。版权所有 © 2024。由 Elsevier Inc. 出版。

This study aimed to evaluate the efficacy of local ablative therapy (LAT) combined with pembrolizumab in patients with synchronous oligometastatic non-small cell lung cancer (NSCLC) and to identify patients who would most benefit from LAT.We retrospectively identified patients diagnosed with synchronous oligometastatic NSCLC (≤5 metastatic lesions and ≤3 organs involved) and treated with first-line pembrolizumab between January 2017 and December 2022. Patients who underwent LAT, including surgery or radiotherapy at all disease sites, were compared with those who did not undergo LAT. A recursive partitioning analysis (RPA) model was developed using prognostic factors for progression-free survival (PFS).Among the 258 patients included, 78 received LAT with pembrolizumab and 180 received pembrolizumab alone. The median follow-up duration was 15.5 months (range, 3.0-71.2). In the entire cohort, LAT was independently associated with significantly improved PFS (hazard ratio [HR], 0.64; P = 0.015) and overall survival (OS) (HR, 0.61; P = 0.020). In the propensity score-matched cohort (N = 74 in each group), the median PFS was 19.9 months and 9.6 months, respectively (P = 0.003), and the median OS was 42.2 months and 20.5 months, respectively (P = 0.045), for the LAT and non-LAT groups. Based on the RPA model, incorporating the number of metastatic lesions, performance status, and PD-L1 expression level, patients were stratified into three risk groups with distinct PFS. LAT significantly improved PFS and OS in the low- and intermediate-risk groups; however, no difference was observed in the high-risk group. LAT was more effective as a consolidative treatment following pembrolizumab initiation than as an upfront therapy.LAT combined with pembrolizumab was associated with higher PFS and OS compared to pembrolizumab alone in selected patients with synchronous oligometastatic NSCLC. The RPA model could serve as a valuable clinical tool for identifying appropriate patients for LAT.Copyright © 2024. Published by Elsevier Inc.