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Improved survival with SBRT plus PD-1/PD-L1 inhibitors in lung metastases patients: A propensity score-matched study

Year: 2026

Type: article

Abstract: This study compares stereotactic body radiotherapy (SBRT) alone versus SBRT combined with immunotherapy (SBRT+IT) for pulmonary metastases. In a retrospective analysis of patients from Sir Run Run Shaw Hospital, cohorts were balanced using propensity score matching. While local control was similar between groups, the SBRT+IT group demonstrated a significantly superior median overall survival (51.3 vs. 35.5 months, P < 0.05), indicating a systemic benefit from immunotherapy. Multivariable analysis identified C-reactive protein (CRP), the CRP-to-albumin ratio (CAR), and the CRP-to-lymphocyte ratio (CLR) as independent prognostic factors for SBRT+IT outcomes, with low baseline levels predicting longer survival. The receiver operating characteristic analysis demonstrated three markers possessed good to excellent predictive ability for short-term survival. We conclude that combining SBRT with immunotherapy significantly improves survival compared to SBRT alone, primarily through systemic immune activation rather than enhanced local tumor control. Furthermore, CRP, CAR, and CLR serve as robust prognostic biomarkers for this combination strategy, highlighting the clinical value of this synergistic approach for improving the prognosis of patients with lung metastases. • SBRT plus immunotherapy shows significant survival benefit and a manageable safety profile in lung metastases. • The survival benefit stems from systemic immunity beyond SBRT's local control, indicating an abscopal effect. • A propensity score-matched study confirms the benefit and identifies CRP, CAR, and CLR as prognostic biomarkers.

Source: International Immunopharmacology

DOI: 10.1016/j.intimp.2026.116379

Authors: Yunjie Zhang, Jingjing Shan, Runyin Huang, Wei Wei, Hai Liu

Institutions: Sir Run Run Shaw Hospital, Zhejiang University

Language: English

Topic: Lung Cancer Diagnosis and Treatment

Subfield: Pulmonary and Respiratory Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $3,220