恶病质对信迪利单抗免疫治疗非小细胞肺癌疗效的影响  

The influence of cachexia on the immunotherapy efficacy of Sintilimab for non-small cell lung cancer

作　　者：李锡清[1] 赵尊兰[1] 候梦琳 崔勇霞[1] 韩双印[1] 付芳芳[1] Li Xiqing;Zhao Zunlan;Hou Menglin;Cui Yongxia;Han Shuangyin;Fu Fangfang(Henan Provincial People′s Hospital Cancer Center,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院肿瘤中心,郑州450003

出　　处：《中华肿瘤杂志》2021年第12期1292-1297,共6页Chinese Journal of Oncology

摘　　要：目的探讨恶病质对免疫检查点抑制剂治疗非小细胞肺癌(NSCLC)疗效的影响。方法回顾性分析2019—2021年河南省人民医院62例晚期NSCLC患者接受抗程序性死亡受体1(PD-1)治疗的疗效,分别于免疫治疗前、免疫治疗2个周期后评估患者恶病质情况。生存分析采用Kaplan-Meier法和Log rank,多因素分析采用Cox回归模型,相关分析采用Spearman相关性分析。结果免疫治疗2个周期后,恶病质组和对照组患者的骨骼肌截面面积(PMMA)分别为(14.10±4.09)cm2和(11.66±3.22)cm2,差异有统计学意义(P=0.001)。前白蛋白水平和体重与恶病质有关(P<0.05)。全组62例患者6个月和1年生存率分别为58.6%和42.5%。对照组患者无进展生存时间(PFS)高于恶病质组(分别为7.6和3.8个月,P=0.006),高表达程序性死亡受体配体1(PD-L1)患者PFS(7.1个月)长于低表达PD-L1者(3.8个月,P=0.009);恶病质组患者总生存时间(OS)低于对照组(分别为6.3和18.2个月,P=0.006);PD-L1高表达患者OS(14.5个月)高于低表达者(1个月,P=0.038)。前白蛋白水平、PD-L1表达水平和PMMA变化率与患者的总生存有关(均P<0.05),前白蛋白水平和PMMA变化率为总生存的独立影响因素(均P<0.05)。PMMA和前白蛋白水平呈负相关(r=-0.0038,P<0.05)。结论在抗PD-1的免疫检测点抑制剂治疗中恶病质的发生对患者的预后有负面影响。Objective To investigate whether cachexia affects the treatment effect of immune checkpoint inhibitors for non-small cell lung cancer(NSCLC).Methods The prognosis of 62 patients with advanced NSCLC who received anti-programmed cell death-1(PD-1)in Henan Provincial People′s Hospital from 2019 to 2021 were retrospectively analyzed.The cachexia was evaluated before and after the second course of immunotherapy.Kaplan-Meier and Log rank methods were used for survival analysis,Cox regression model was used for multivariate analysis,and Spearman′s correlation analysis was used for correlation analysis.Results After the second course of immunotherapy,psoas major muscle area(PMMA)values of the cachexia group and the control group were(14.10±4.09)and(11.66±3.22)cm2 respectively,with statistics significance(P=0.001).The level of Prealbumin and body weight were correlated with cachexia(P<0.05).The 6-month and 1-year survival rates of 62 cases in the whole group were 58.6%and 42.5%,respectively.The progression-free survival(PFS)in the control group(7.6 months)was higher than that in the cachexia group(3.8 months,P=0.006).The PFS in patients with high expression of PD-L1(7.1 months)was longer than that of patients with low expression(3.8 months,P=0.009).The overall survival(OS)in the cachexia group(6.3 months)was lower than that in the control group(18.2 months,P=0.006).The OS in patients with high expression of PD-L1(14.5 months)was longer than that of patients with low expression(1 months,P=0.038).The level of Prealbumin,the level of PD-L1 expression and the change rate of PMMA were related to the OS of the patients(P<0.05).The level of Prealbumin and the change rate of PMMA were the independent influencing factors of the OS(P<0.05).The PMMA and the level of Prealbumin were negatively correlated(r=-0.0038,P<0.05).Conclusion Cachexia has a negative impact on the outcomes of patients who received anti-PD-1 immune checkpoint inhibitor therapy.

关 键 词：肺肿瘤 免疫治疗 免疫检查点抑制剂 程序性死亡受体1抗体 恶病质 第3腰椎骨骼肌的面积 

分 类 号：R734.2[医药卫生—肿瘤]