免疫检查点抑制剂 (ICI) 单药疗法和 ICI 联合化疗被批准为表达高水平程序性细胞死亡配体 1 (PD-L1) 的非小细胞肺癌 (NSCLC) 患者的一线治疗方法。然而，针对 PD-L1 高表达和体能状态 (PS) 较差的患者的适当治疗尚未明确。本研究的目的是确定在现实环境中更适合这些患者的治疗选择。回顾性纳入 425 例 PD-L1 高表达 NSCLC 患者。所有患者均接受派姆单抗单药治疗或 ICI 加化疗作为一线治疗。患者被分为良好（PS 得分 0 或 1；n = 354）和较差 PS 组（PS 得分 2 或 3；n = 71）。早期进展性疾病（PD）定义为基于ICI的治疗开始后3个月内的PD。在基于ICI的治疗后，良好PS组的无进展生存期（PFS）和总生存期（OS）明显长于PS较差组行政。在 PS 差组中，派姆单抗单药治疗与 ICI 加化疗之间的 PFS 和 OS 没有观察到显着差异。根据多变量逻辑回归分析确定，在良好 PS 组中，派姆单抗单药治疗、PD-L1 50-89% 和肝转移与早期 PD 相关。然而，在 PS 较差的患者中，多变量 Logistic 回归分析并未显示派姆单抗单药治疗与早期 PD 之间存在关联。在 PS 较差且 PD-L1 表达较高的 NSCLC 患者中，ICI 联合化疗并没有带来 PFS 或 OS 获益。使用 pembrolizumab 单药疗法。© 2023。作者，获得 Springer Nature Switzerland AG 的独家许可。

Immune checkpoint inhibitor (ICI) monotherapy and ICI plus chemotherapy are approved first-line treatments for patients with non-small cell lung cancer (NSCLC) expressing high levels of programmed cell death-ligand 1 (PD-L1). However, appropriate treatment for patients showing high PD-L1 expression and poor performance status (PS) is not well defined.The aim of this study was to identify a treatment option that is better for these patients in a real-world setting.A total of 425 patients with NSCLC and high PD-L1 expression were included retrospectively. All patients received either pembrolizumab monotherapy or ICI plus chemotherapy as the first-line treatment. Patients were subdivided into good (PS score 0 or 1; n = 354) and poor PS groups (PS score 2 or 3; n = 71). Early progressive disease (PD) was defined as PD within 3 months of ICI-based therapy initiation.The good PS group had significantly longer progression-free survival (PFS) and overall survival (OS) than the poor PS group upon ICI-based therapy administration. In the poor PS group, no significant difference was observed in PFS and OS between pembrolizumab monotherapy and ICI plus chemotherapy. In the good PS group, pembrolizumab monotherapy, PD-L1 50-89%, and liver metastasis were associated with early PD, as determined using multivariate logistic regression analyses. However, in the poor PS group, the multivariate logistic regression analyses did not show an association between pembrolizumab monotherapy and early PD.In patients with NSCLC exhibiting poor PS and high PD-L1 expression, ICI plus chemotherapy did not confer PFS or OS benefit compared with pembrolizumab monotherapy.© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.