30- und 90-Tage-Letalität bei Patienten mit Lungenkarzinom im Stadium IV in Abhängigkeit der Primärtherapie

Zusammenfassung

Die frühe Letalität nach der Therapieeinleitung bei Patienten mit Lungenkarzinom im Stadium IV stand bisher selten im Fokus wissenschaftlicher Arbeiten. Die wenige verbleibende Zeit zwischen Diagnosestellung, Therapiebeginn und Todeseintritt sowie die evtl. beeinflussenden Faktoren beschäftigen jedoch Patienten und Behandler in hohem Maße. Entsprechend ist das Ziel dieser Arbeit die 30- und 90-Tage-Letalität nach Einleitung einer First-Line-Therapie zu analysieren und mögliche Einflussfaktoren auf eine frühe Letalität zu eruieren. Hierzu wurden retrospektiv die Daten von 225 Patienten mit Lungenkarzinom im Stadium IV und Behandlung im Lungenkrebszentrum Martha-Maria Halle-Dölau und in der Lungenklinik Ballenstedt im Zeitraum vom 01.01.2017 bis zum 18.05.2020 erfasst. Therapieformen und Patientenmerkmale wurden mittels Häufigkeitsverteilung analysiert und die Überlebenswahrscheinlichkeiten durch die Kaplan-Meier-Methode geschätzt. Die Analyse der frühen Letalität aller tumorspezifisch behandelten Patienten brachte zum Zeitpunkt 30 Tage nach Therapiebeginn eine Letalität von 8,5% und nach 90 Tagen eine Rate von 23,5%. Im direkten Vergleich der unterschiedlichen Therapiegruppen fielen die Patienten mit einer Monotherapie mit Checkpointinhibitoren mit einer höheren Letalität auf (16,6% nach 30 Tagen und 44,3% nach 90 Tagen). Hingegen blieb die Letalität der Patienten der anderen Therapiegruppen bei unter 10% nach 30 Tagen und unter 23,3% nach 90 Tagen. Als Prädiktoren für eine höhere frühe Letalität konnten ein schlechter Allgemeinzustand, eine fortgeschrittene Tumorerkrankung, eine Polymetastasierung sowie die positive Raucheranamnese eruiert werden. Dagegen bestand kein relevanter Unterschied der Letalität zwischen den unterschiedlichen Tumorentitäten, dem Geschlecht sowie dem PD-L1- und Mutationsstatus. Mit dieser Analyse konnte eine sehr hohe, mit anderen Untersuchungen vergleichbare frühe Letalität bei Patienten mit Lungenkarzinom nachgewiesen werden. Relevante Unterschiede zwischen den Therapieformen verdeutlichen die Wichtigkeit einer individuellen Patientenselektion zu den jeweiligen Therapieoptionen und die rasche Entscheidung zu einer Therapieeinleitung.

Abstract

Early lethality after initiation of therapy in patients with stage IV lung cancer has rarely been the focus of scientific studies yet. The little time remaining between diagnosis, start of therapy and onset of death, as well as any influencing factors, are of special interest for both, patients and physician. Accordingly, the aim of this work was to analyze the 30- and 90-day morbidity after initiation of systemic therapy and to determine possible factors influencing early lethality. For this purpose, the data of 225 patients with stage IV lung cancer and treatment at the Martha-Maria Halle-Dölau Lung Cancer Center between 01/01/2017 and 05/18/2020 were retrospectively analyzed. Forms of therapy and patient characteristics were analyzed with a frequency distribution and the probability of survival was estimated using the Kaplan-Meier method. The analysis of the early morbidity of all tumor-specifically treated patients showed a morbidity of 8.5% at day 30 after the start of therapy and a rate of 23.5% after 90 days. In a direct comparison of the different therapy groups, the patients receiving mono-checkpointinhibition had higher lethality (16.6% after 30 days and 44.3% after 90 days). In contrast, the morbidity of patients in the other therapy groups remained below 10% after 30 days and below 23.3% after 90 days. A poor general condition, an advanced tumor disease, polymetastasis and a positive history of smoking could be determined as predictors for higher early lethality. In contrast, there was no relevant difference in morbidity between the different tumor entities, gender, PD-L1 and mutation status. With this analysis, very high early lethality, comparable to other studies, could be detected in patients with lung cancer. Relevant differences between the forms of therapy illustrate the importance of individual patient selection for the respective therapy options and the rapid decision to initiate therapy.

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