摘要
目的:探索全身免疫炎症指数(systemic immune inflammation index,SII)等炎性指标在非小细胞肺癌(non-small cell lung cancer,NSCLC)患者程序性死亡受体1(programmed cell death-1,PD-1)抗体治疗中的疗效预测及预后价值。方法:回顾性分析2018年1月至2020年10月在天津医科大学肿瘤医院接受PD-1抗体治疗的64例Ⅲb~Ⅳ期NSCLC患者的血液学及临床资料。单因素方差分析比较治疗前、取得最佳疗效时以及疾病进展时不同时间各炎性指标的差异;通过受试者工作特征曲线(receiver operating characteristic curve,ROC)确定炎性指标的最佳临界值;通过χ2检验和Kaplan-Meier生存曲线分析各指标与患者生存的相关性。结果:NSCLC患者的炎性指标在取得最佳疗效时均较基线明显下降,而在疾病进展时再次升高。SII、粒细胞/淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)、单核细胞/淋巴细胞比值(monocyte-to-lymphocyte ratio,MLR)、血小板/淋巴细胞比值(platelet-to-lymphocyte ratio,PLR)的最佳临界值分别为822.39、4.20、269.85和0.58;血清中炎症相关因子γ-谷氨酰转肽酶(γ-GGT)、乳酸脱氢酶(LDH)、纤维蛋白原(Fbg)、D-二聚体(D-dimer)的最佳临界值分别为55.00 U/L、255.00 U/L、3.94 g/L和1513.19 ng/mL。高SII、PLR、LDH、Fbg和D-dimer预示NSCLC患者较差的无进展生存期(progressionfree survival,PFS)(P<0.05)。多因素分析结果显示,基线LDH是PFS的独立风险因素(P=0.016)。结论:在晚期NSCLC中,患者基线炎性指标高提示PD-1抗体疗效相对较差,动态监测炎性指标可以预测PD-1抗体治疗效果,并对患者预后具有一定的提示意义。
Objective:To determine the value of the systemic immune inflammation index(SII)and other inflammatory factors in predicting the efficacy and prognosis of anti-PD-1 antibody treatment in non-small cell lung cancer(NSCLC)patients.Methods:We retrospectively analyzed the hematological and clinical data of 64 stageⅢB-ⅣNSCLC patients treated with anti-PD-1 antibodies.One-way analysis of variance was used to evaluate all inflammatory indexes at different time points:before treatment,when the best curative effect was achieved,and when the disease progressed.Meanwhile,the optimal critical values of inflammatory indexes were determined using receiver operating characteristic curve(ROC)analysis.The correlations between these indexes and patient survival were analyzed using the chi-square test and Kaplan–Meier estimation.Results:The inflammatory indexes were significantly lower when the best curative effect was achieved than at the baseline;however,these values increased again when the disease progressed.The optimal critical values for SII,neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR),and monocyte-to-lymphocyte ratio(MLR)were 822.39,4.20,0.58,and 269.85,respectively.Moreover,the best cut-off values of serum levels of inflammation-related factors such asγ-glutamyl transferase(γ-GGT),lactate dehydrogenase(LDH),fibrinogen(Fbg),and D-dimer were 55.00 U/L,255.00 U/L,3.94 g/L and 1,513.19 ng/mL,espectively;higher PLR,SII,LDH,Fbg,and D-dimer values predicted poorer progression-free survival(PFS)in NSCLC patients(P<0.05).Multivariate analysis showed that the baseline LDH level was an independent risk factor for PFS(P=0.016).Conclusions:In patients with advanced NSCLC,high baseline levels of inflammatory markers indicate relatively poor efficacy of anti-PD-1 antibodies.Thus,dynamic monitoring of inflammatory markers can predict the efficacy of anti-PD-1 antibody treatment and has a certain role in the prognostication of patients.
作者
魏熙胤
张翠翠
臧凤琳
陈鹏
Xiyin Wei;Cuicui Zhang;Fenglin Zang;Peng Chen(Department of Public Laboratory,Tianjin Lung Cancer Center,Tianjin Medical University Cancer Institute and Hospital,National Clinical Research Center for Cancer,Tianjin Key Laboratory of Cancer Prevention and Therapy,Tianjin’s Clinical Research Center for Cancer,Tianjin 300060,China;Department of Thoracic Oncology,Tianjin Lung Cancer Center,Tianjin Medical University Cancer Institute and Hospital,National Clinical Research Center for Cancer,Tianjin Key Laboratory of Cancer Prevention and Therapy,Tianjin’s Clinical Research Center for Cancer,Tianjin 300060,China;Department of Pathology,Tianjin Lung Cancer Center,Tianjin Medical University Cancer Institute and Hospital,National Clinical Research Center for Cancer,Tianjin Key Laboratory of Cancer Prevention and Therapy,Tianjin’s Clinical Research Center for Cancer,Tianjin 300060,China)
出处
《中国肿瘤临床》
CAS
CSCD
北大核心
2021年第11期547-552,共6页
Chinese Journal of Clinical Oncology
基金
天津科学技术委员会重大项目(编号:18ZXDBSY00050)
天津医科大学肿瘤医院临床试验基金一般项目(编号:C1712)资助。
关键词
炎性指标
免疫治疗
非小细胞肺癌
预后
inflammatory marker
immunotherapy
non-small cell lung cancer(NSCLC)
prognosis
