CD8^(+)T淋巴细胞联合治疗线数对晚期肺癌免疫治疗疗效的预测价值  

The predictive value of CD8^(+)T lymphocyte combination therapy line number in immunotherapy of advanced lung cancer

作　　者：吴侃 徐晓 张敏娜 杨邵瑜 李鑫[2] 朱鲁程 王冰 汤艺 夏冰 陈雪琴 马胜林 Wu Kan

机构地区：[1]浙江大学医学院附属杭州市肿瘤医院,310002 [2]浙江大学医学院附属杭州市第一人民医院,310006

出　　处：《浙江临床医学》2021年第3期320-323,共4页Zhejiang Clinical Medical Journal

基　　金：浙江省自然科学基金资助项目(LQ20H160019)。

摘　　要：目的基于临床特征和细胞免疫功能,分析晚期肺癌患者免疫检查点抑制剂治疗疗效预测指标。方法回顾性分析2017至2020年84例接受免疫检查点抑制剂治疗晚期肺癌患者临床资料,根据iRECIST标准进行疗效评估,分为治疗有效组和治疗无效组。采集患者临床资料、治疗前1周内细胞免疫功能,分析各指标与疗效的相关性。结果治疗有效组较治疗无效组患者有较高的一线治疗比例和淋巴细胞总效、CD3^(+)T细胞数、CD8^(+)T细胞数,以及较低的激素使用率和免疫调节细胞百分比。Logistic多因素分析显示后线治疗(P<0.001)及基线低CD8^(+)T淋巴细胞(P=0.003)是治疗无效的独立危险因素。ROC曲线分析显示治疗线数和基线CD8^(+)T淋巴细胞联合预测疗效的曲线下面积为0.853,敏感度0.882,特异度0.733。结论治疗线数联合基线CD8T淋巴细胞对于预测肺癌患者免疫检查点抑制剂疗效有一定的价值。Objective To analyze the predictive value of clinical charatenstics and cellular immune function in the therapeutic effect of advanced lung cancer patients treated with’checkpoint inhibitor-based immunotherapy.Methods A total of 84 advanced lung cancer patients treated with checkpoint inhibitor in our hospital from 2017 through 2020 were reviewed.Patients were divided into response group and non-response group according to modified Response Evaluation Criteria in Solid Tumors 1.1 for immune based therapeutics(iRJECIST v1.1).Cellular immune function a week before immunotherapy and clinical charateristics were tested to analyze the correlation with best response.Results Higher first line treatment ratio,lymphocyte,CD3^(+)T cell,CD8^(+)T cell counts and lower glucocorticoid treatment ratio,immunoregulatory cell ratio were found in the response group than in the non-response group.Based on the multivariate analysis,factors predictive of non-response included late-line treatment(P<0.001)and fewerCD8^(+)T lymphocytes before treatment(P=0.003)The area of ROC curve of treatment line combined withCD8^(+)T cell counts in prediction of best response was 0.853,and the sensitivity was 0.882,the specificity was 0.733.Conclusion BasicCD8^(+)T cell counts before treatment combined with treatment line may be an important factor for predicting the best response of advanced lung cancer when checkpoint inhibitor-based immunotherapy is used;but this observation needs to be validated in future studies.

关 键 词：免疫检查点抑制剂治疗 肺癌 治疗线数 CD8^(+)T淋巴细胞 最佳疗效 

分 类 号：R73[医药卫生—肿瘤]