摘要
目的研究肺免疫预后指数(lung immune prognostic index,LIPI)评分与晚期胃癌患者免疫检查点抑制剂治疗疗效及预后的关系。方法选取2015年5月-2018年12月在解放军总医院第一医学中心和第二医学中心接受免疫检查点抑制剂(包括PD-1/PD-L1抗体、CTLA-4抗体)治疗的晚期胃癌患者72例。通过治疗前中性粒细胞/(白细胞-中性粒细胞)比值(dNLR)预测疾病控制状态的ROC曲线得出dNLR的截断值,根据是否大于dNLR截断值和乳酸脱氢酶(LDH)是否超过正常值将患者分为LIPI评分优组和中/差组。比较两组免疫治疗后的疾病控制率、总体生存时间(OS)和无进展生存时间(PFS)。结果72例入组患者平均年龄60.1岁,其中男性46例,女性26例。dNLR的截断值为1.91,结合LDH指标进行LIPI评分分组,优组35例,中/差组37例。与LIPI评分为优相比,评分为中/差与疾病进展有明显相关(OR=3.99,95%CI:1.27~12.54,P=0.018);在预后方面,LIPI优组和中/差组的中位OS分别为11.6个月(95%CI:4.5~18.7)和5.4个月(95%CI:4.2~6.6),中位PFS分别为7.4个月(95%CI:3.4~11.4)和2.7个月(95%CI:1.2~4.2),差异均有统计学意义(P均<0.05)。多元Cox回归分析显示LIPI评分为中或差是影响总生存时间的独立危险因素(HR:2.68;95%CI:1.52~4.73;P=0.001)。结论基于dNLR和乳酸脱氢酶的LIPI评分与晚期胃癌患者免疫治疗的疗效及预后均相关,但LIPI评分能否作为一种有效的预后指标仍需大样本、前瞻性的临床研究进一步证实。
Objective To investigate whether the lung immune prognostic index(LIPI)is associated with the clinical efficacy and outcomes of advanced gastric cancer patients treated with immune checkpoint inhibitors(ICIs).Methods Clinical data about 72 patients treated with ICIs in the first and second medical center of Chinese PLA General Hospital from May 2015 to December 2018 were analyzed retrospectively.The cut-off value of neutrophils/(leukocytes minus neutrophils)ratio(dNLR)was calculated by ROC curve according to the disease control status.Patients were classified into LIPI-good group and LIPI-intermediate/poor group based on cut-off value of dNLR and upper limit of normal range of lactate dehydrogenase(LDH)before treatment.Then the disease control rate,progression-free survival and overall survival were compared between the two groups.Results The average age of the 72 enrolled patients was 60.1 years old,and 35 patients(48.6%)were in the LIPI-good group,and 37 patients(51.4%)were in the LIPI-intermediate/poor groups.Compared to LIPI-good group,the intermediate/poor group had higher rate of disease progression(OR,3.99;95%CI,1.27-12.54;P=0.018).Median OS was 11.6(95%CI,4.5-18.7)months in good LIPI group,and 5.4(95%CI,4.2-6.6)months in intermediate/poor group;The median PFS was 7.4(95%CI,3.4-11.4)months,and 2.7(95%CI,1.2-4.2)months(P<0.05,respectively).Multivariate COX regresssion analysis showed that intermediate or poor LIPI was independently associated with OS(HR 2.68,95%CI,1.52-4.73,P=0.001).Conclusion The pretreatment LIPI is significantly correlated with worse outcomes for advanced gastric cancer patients treated with ICIs.However,the determination of whether LIPI can screen beneficial patients still needs to be further confirmed through studies with large sample size and prospective clinical trials.
作者
侯柏村
刘婷婷
李涛
胡毅
HOU Baicun;LIU Tingting;LI Tao;HU Yi(Chinese PLA Medical School,Beijing 100853,China;Department of Gastroenterology,the Second Medical Center,Chinese PLA General Hospital,Beijing 100853,China;Department of Respiratory Medicine,the Second Medical Center,Chinese PLA General Hospital,Beijing 100853,China;Department of Oncology,the First Medical Center,Chinese PLA General Hospital,Beijing 100853,China)
出处
《解放军医学院学报》
CAS
2020年第5期436-439,445,共5页
Academic Journal of Chinese PLA Medical School
基金
中央军委后勤保障部卫生局军事医学创新工程专项(16CXZ042)
关键词
肺免疫预后指数评分
胃癌
免疫检查点抑制剂
总生存期
无进展生存期
lung immune prognostic index
gastric cancer
immune checkpoint inhibitors
overall survival
progression-free survival
