在晚期非小细胞肺癌 (NSCLC) 中，对于体弱患者和体力状态 (PS) 较差的患者，免疫检查点抑制剂 (ICI) 单药治疗通常优于强化 ICI 治疗。在 PS 较差的患者中，虚弱对治疗选择和死亡率的额外影响尚不清楚。2019 年 1 月至 2021 年 12 月参加退伍军人事务部国家精准肿瘤学计划的晚期 NSCLC 接受一线 ICI 的患者均被随访直至死亡或研究截止日期 6/2022。使用 PS 分层逻辑回归检查电子衰弱指数与治疗选择的关联。我们还使用按 PS 分层的 Cox 回归检查了强化治疗的总生存期 (OS)。强化治疗被定义为同时使用铂类双联化疗和/或双重检查点阻断，非强化治疗为 ICI 单药治疗。 在接受任何 ICI 的 1547 名患者中，66.2% 虚弱，33.8% 的 PS 较差（≥2），25.8% ％ 均。在两个 PS 亚组中，虚弱患者接受的强化治疗均少于非虚弱患者（良好 PS：比值比 [OR] 0.67，95% 置信区间 [CI] 0.51 - 0.88；差 PS：OR 0.69，95% CI 0.44 - 1.10） 。在接受强化治疗的 731 名患者中，对于 PS 良好的患者来说，虚弱与较低的 OS 相关（风险比 [HR] 1.53，95% CI 1.2 - 1.96），但没有观察到与 PS 较差的患者存在关联（HR 1.03，95% CI 0.67） - 1.58)。PS 良好和较差的虚弱患者接受的强化治疗较少。然而，虚弱对 PS 较差的患者的生存影响有限。这些发现表明，在强化治疗中，推动生存的是 PS，而不是虚弱。© 2024。这是美国政府的作品，在美国不受版权保护；外国版权保护可能适用。

In advanced non-small cell lung cancer (NSCLC), immune checkpoint inhibitor (ICI) monotherapy is often preferred over intensive ICI treatment for frail patients and those with poor performance status (PS). Among those with poor PS, the additional effect of frailty on treatment selection and mortality is unknown.Patients in the veterans affairs national precision oncology program from 1/2019-12/2021 who received first-line ICI for advanced NSCLC were followed until death or study end 6/2022. Association of an electronic frailty index with treatment selection was examined using logistic regression stratified by PS. We also examined overall survival (OS) on intensive treatment using Cox regression stratified by PS. Intensive treatment was defined as concurrent use of platinum-doublet chemotherapy and/or dual checkpoint blockade and non-intensive as ICI monotherapy.Of 1547 patients receiving any ICI, 66.2% were frail, 33.8% had poor PS (≥ 2), and 25.8% were both. Frail patients received less intensive treatment than non-frail patients in both PS subgroups (Good PS: odds ratio [OR] 0.67, 95% confidence interval [CI] 0.51 - 0.88; Poor PS: OR 0.69, 95% CI 0.44 - 1.10). Among 731 patients receiving intensive treatment, frailty was associated with lower OS for those with good PS (hazard ratio [HR] 1.53, 95% CI 1.2 - 1.96), but no association was observed with poor PS (HR 1.03, 95% CI 0.67 - 1.58).Frail patients with both good and poor PS received less intensive treatment. However, frailty has a limited effect on survival among those with poor PS. These findings suggest that PS, not frailty, drives survival on intensive treatment.© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.