晚期NSCLC一线ICI治疗期间早期功能恶化：对支持性护理的意义。
完整摘要 · 中文译文
目的：比较客观功能指标在识别晚期非小细胞肺癌（NSCLC）一线免疫检查点抑制剂（ICI）治疗期间早期功能恶化中的作用，并探讨其与支持性照护监测的相关性。 方法：本二次探索性分析使用了一项肺康复随机试验中前瞻性收集的数据。42名具有基线和8周评估的参与者接受了股四头肌肌力、SPPB和6MWD评估。早期恶化定义为至少一个领域出现下降。研究考察了恶化频率、跨领域一致性、基线相关性及后续PFS，并考虑了随机治疗分配。 结果：在主要操作定义下，尽管ECOG体能状态稳定，29/42名参与者（69.0%）出现至少一个功能领域的恶化。恶化涉及股四头肌肌力23例（54.8%）、SPPB 14例（33.3%）、6MWD 5例（11.9%）；16名参与者在一个领域恶化，13名在两个领域恶化。各指标间恶化频率差异显著（Cochran's Q=16.76，p<0.001），两两一致性较低。在调整PR/UC分配后，所考察的基线特征均与恶化无显著关联。恶化参与者的后续PFS在数值上较差，但该关联无统计学显著性。 结论：一线ICI治疗期间早期功能恶化常见且在各领域间表现异质。跨互补功能指标进行重复客观评估可能有助于识别新出现的 评估功能脆弱性，并支持及时开展个体化支持性照护评估。
完整摘要 · 英文原文
PURPOSE: To compare objective functional measures for identifying early functional deterioration during first-line ICI-based therapy in advanced NSCLC and explore their relevance for supportive-care monitoring. METHODS: This secondary exploratory analysis used prospectively collected data from a randomized trial of pulmonary rehabilitation. Forty-two participants with baseline and 8-week assessments were evaluated using quadriceps force, SPPB, and 6MWD. Early deterioration was defined as decline in at least one domain. Deterioration frequency, cross-domain agreement, baseline associations, and subsequent PFS were examined, accounting for randomized treatment allocation. RESULTS: Under the primary operational definitions, deterioration in at least one functional domain occurred in 29/42 participants (69.0%) despite stable ECOG performance status. Deterioration affected quadriceps force in 23 (54.8%), SPPB in 14 (33.3%), and 6MWD in 5 (11.9%); 16 participants deteriorated in one domain and 13 in two. Frequencies differed significantly across measures (Cochran's Q=16.76, p<0.001), with low pairwise agreement. No examined baseline characteristic was significantly associated with deterioration after adjustment for PR/UC allocation. Participants with deterioration had numerically less favorable subsequent PFS, but the association was not statistically significant. CONCLUSION: Early functional deterioration during first-line ICI-based therapy was common and heterogeneous across domains. Repeated objective assessment across complementary functional measures may help identify emerging functional vulnerability and support timely individualized supportive-care evaluation.