摘要
背景与目的肺癌是癌症相关死亡最主要的病因,其中非小细胞肺癌(non small cell lung cancer, NSCLC)是最常见的类型。目前免疫检查点抑制剂(immune checkpoint inhibitors, ICIs)已经成为晚期NSCLC主要的治疗方法之一。本文回顾性研究了外周血炎症指标对晚期NSCLC患者免疫治疗疗效及生存预后的影响,以寻找指导NSCLC免疫治疗的策略。方法选取2018年10月-2019年8月于南京医科大学附属肿瘤医院住院治疗的晚期NSCLC患者,均接受抗PD-1(Pembrolizumab、Sintilimab或Toripalimab)单药或者联合方案治疗。随访至2020年12月10日,根据RECIST1.1标准评价疗效,分析影响疗效的显著变量,并随访无进展生存期(progression-free survival, PFS)及总生存期(overall survival, OS)进行生存分析。根据治疗前、治疗后6周、治疗后12周(0 w、6 w、12 w)三个不同时间点中性粒细胞计数与淋巴细胞计数比值(neutrophil-to-lymphocyte ratio, NLR)数据构建临床预测模型分析NLR的预测价值,并验证模型准确性。结果最终纳入173例患者,所有患者均接受上述治疗方案,中位随访时间19.7个月。客观缓解率(objective response rate, ORR)27.7%(48/173),疾病控制率(disease control rate, DCR)89.6%(155/173),中位PFS为8.3个月(7.491-9.109),中位OS为15.5个月(14.087-16.913)。χ^(2)检验及Logistic多因素分析显示NLR_(6w)与ORR相关,NLR_(12w)与ORR、DCR相关,进一步Cox回归分析显示NLR_(6w)和NLR_(12w)影响PFS,NLR_(0w)、NLR_(6w)和NLR_(12w)与OS相关。结论在晚期NSCLC患者中,不同时间点的NLR数值是免疫治疗反应的有效预测因子,并且NLR<3往往与良好的预后相关。
Background and objective Lung cancer is the leading cause of cancer-related death, of which nonsmall cell lung cancer(NSCLC) is the most common type. Immune checkpoint inhibitors(ICIs) have now become one of the main treatments for advanced NSCLC. This paper retrospectively investigated the effect of peripheral blood inflammatory indexes on the efficacy of immunotherapy and survival of patients with advanced non-small cell lung cancer, in order to find strategies to guide immunotherapy in NSCLC. Methods Patients with advanced non-small cell lung cancer who were hospitalized in The Affiliated Cancer Hospital of Nanjing Medical University from October 2018 to August 2019 were selected to receive anti-PD-1(pembrolizumab, sintilimab or toripalimab) monotherapy or combination regimens. And were followed up until 10 December 2020, and the efficacy was evaluated according to RECIST1.1 criteria. Progression-free survival(PFS) and overall survival(OS) were followed up for survival analysis. A clinical prediction model was constructed to analyze the predictive value of neutrophil-to-lymphocyte ratio(NLR) based on NLR data at three different time points: before treatment, 6 weeks after treatment and 12 weeks after treatment(0w, 6w and 12w), and the accuracy of the model was verified. Results 173 patients were finally included, all of whom received the above treatment regimen, were followed up for a median of 19.7 months. The objective response rate(ORR) was 27.7%(48/173), the disease control rate(DCR) was 89.6%(155/173), the median PFS was 8.3 months(7.491-9.109) and the median OS was 15.5 months(14.087-16.913). The chi-square test and logistic multi-factor analysis showed that NLR_(6w) was associated with ORR and NLR_(12w) was associated with ORR and DCR. Further Cox regression analysis showed that NLR_(6 w) and NLR_(12w) affected PFS and NLR_(0w), NLR_(6w) and NLR_(12w) were associated with OS. Conclusion In patients with advanced non-small cell lung cancer, NLR values at different time points are valid predictors of resp
作者
夏经纬
陈羽中
温少迪
杜晓月
沈波
Jingwei XIA;Yuzhong CHEN;Shaodi WEN;Xiaoyue DU;Bo SHEN(The Affiliated Cancer Hospital of Nanjing Medical University,Jiangsu Cancer Hospital,Jiangsu Institute of Cancer Research,Nanjing 210009,China)
出处
《中国肺癌杂志》
CAS
CSCD
北大核心
2021年第9期632-645,共14页
Chinese Journal of Lung Cancer
基金
白求恩公益基金会(No.G-X-2019-0101-12)
中国健康促进基金会(No.Z078001)资助。
