外周血标志物对晚期非小细胞肺癌免疫相关不良反应的预测作用及与生存结局的相关性分析  

Predictive effect of peripheral blood markers on immune-related adverse reactions of advanced non-small cell lung cancer and their correlation with survival outcome

作　　者：徐子涵 于国华[2] 聂玉辉 孙蒙蒙 丰慧 刘淑真[2] XU Zihan;YU Guohua;NIE Yuhui;SUN Mengmeng;FENG Hui;LIU Shuzhen(Clinical Medical College,Weifang Medical University,Weifang 261053,China;Department of Oncology,Weifang People′s Hospital)

机构地区：[1]潍坊医学院临床医学院,潍坊261063 [2]潍坊市人民医院肿瘤内科

出　　处：《实用肿瘤学杂志》2022年第6期544-550,共7页Practical Oncology Journal

摘　　要：目的 探讨NLR、PLR和LDH检测对晚期非小细胞肺癌(NSCLC)发生免疫相关不良反应(irAEs)的预测作用,并分析其与生存结局的相关性。方法 回顾性分析2017年1月1日—2021年1月1日在潍坊市人民医院接受PD-1/PD-L1抑制剂治疗的169例晚期NSCLC患者临床资料,将169例患者分为irAEs组(n=61)和非irAEs组(n=108),比较两组临床资料,绘制ROC曲线确定基线外周血参数预测irAEs发生的临界值,多因素logistic回归分析外周血标志物与irAEs发生的关系,使用Cox回归模型分析无进展生存期(PFS)和总生存期(OS)的影响因素。结果 irAEs组患者的基线外周血NLR、PLR较非irAEs组低,LDH较非irAEs组高(P<0.05);治疗前NLR、PLR、LDH预测irAEs发生的最佳临界值分别为3.18(AUC=0.80)、181.56(AUC=0.62)和209.50(AUC=0.63),多因素logistic回归分析显示低NLR和高LDH是irAEs发生的独立危险因素(P<0.05);低NLR组、低PLR组和低LDH组的PFS及OS均显著优于高NLR组、高PLR组和高LDH组(P<0.05);Cox回归模型显示高NLR、高PLR和高LDH是PFS及OS的独立危险因素。结论 NLR、LDH对晚期NSCLC患者irAEs的发生具有预测价值,高NLR、高PLR和高LDH与晚期NSCLC免疫治疗的预后不良相关。Objective The aim of this study was to investigate the predictive effect of NLR,PLR and LDH on immune-related adverse events(irAEs)in advanced non-small cell lung cancer(NSCLC),and to analyze their correlation between them and survival outcomes.Methods Clinical data of 169 patients with advanced NSCLC who were treated with PD-1/PD-L1 inhibitor in Weifang People′s Hospital from January 1,2017 to January 1,2021 were retrospectively analyzed.These patients were divided into the irAEs group(n=61)and non-irAEs group(n=108).The clinical data of the two groups were compared.Receiver operating characteristic(ROC)curve was drawn to determine the threshold value of baseline peripheral blood parameters to predict the occurrence of irAEs.Multivariate logistic regression analysis was used to explore the relationship between peripheral blood markers and the incidence of irAEs.Cox regression model was used to analyze the influencing factors of progression-free survival(PFS)and overall survival(OS).Results The baseline peripheral blood NLR and PLR of patients in the irAEs group were lower than those in the non-irAEs group, and the LDH was higher than those in the non-irAEs group(P<0.05).The best critical values of NLR,PLR and LDH before treatment for predicting the occurrence of irAEs were 3.18(AUC=0.80),181.56(AUC=0.62),and 209.50(AUC=0.63),respectively.Multivariate logistic regression analysis showed that low NLR and high LDH were independent risk factors for the occurrence of irAEs(P<0.05).The PFS and OS in low NLR,low PLR and low LDH groups were significantly better than those in the high NLR,high PLR and high LDH groups(P<0.05).Cox regression model showed that high NLR,high PLR and high LDH were independent risk factors for PFS and OS.Conclusion NLR and LDH can predict the occurrence of irAEs in advanced NSCLC patients.High NLR,high PLR,and high LDH are associated with poor prognosis of immunotherapy for advanced NSCLC.

关 键 词：非小细胞肺癌 外周血标志物 免疫相关不良反应 预测 预后 

分 类 号：R734.2[医药卫生—肿瘤]