晚期非小细胞肺癌患者应用免疫治疗后出现甲状腺功能异常与疗效的相关性分析  

Correlation Analysis between Thyroid Function Abnormality and Efficacy in Patients with Advanced Non-small Cell Lung Cancer after Immunotherapy

作　　者：王一博 王新娟 程琳 张国俊[1] Yibo WANG;Xinjuan WANG;Lin CHENG;Guojun ZHANG(Department of Pulmonary Medicine,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第一附属医院呼吸内科,郑州450000

出　　处：《中国肺癌杂志》2023年第5期369-376,共8页Chinese Journal of Lung Cancer

基　　金：国家自然科学基金项目(No.81874042)资助。

摘　　要：背景与目的甲状腺功能异常(thyroid function abnormality,TFA)是晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)患者常见的免疫治疗相关不良内分泌事件,但TFA发生的危险因素及其与患者疗效的关系尚不完全清楚。本研究旨在探讨晚期NSCLC患者应用免疫治疗后出现TFA的危险因素及其与疗效的关系。方法回顾性收集2019年7月1日-2021年6月31日就诊于郑州大学第一附属医院的晚期NSCLC患者的临床资料,应用χ²检验及多因素Logistic回归探究TFA发生的影响因素。绘制Kaplan-Meier曲线,采用Log-rank检验进行组间比较,应用单因素及多因素Cox分析探究疗效的影响因素。结果共有86例(43.10%)患者发生TFA,Logistic回归分析发现美国东部肿瘤协作组体能状态(Eastern Cooperative Oncology Group performance status,ECOG PS)、胸腔积液、乳酸脱氢酶(lactic dehydrogenase,LDH)是TFA发生的影响因素(P<0.05);TFA组患者相比于甲状腺功能正常组患者的中位无进展生存期(progression-free survival,PFS)显著延长(19.0个月vs 6.3个月,P<0.001),且TFA组的客观缓解率(objective response rate,ORR)(65.1%vs 28.9%,P<0.001)和疾病控制率(disease control rate,DCR)(100.0%vs 92.1%,P=0.020)均优于甲状腺功能正常组。Cox回归分析示ECOG PS、LDH、细胞角蛋白19片段(cytokeratin 19 fragment,CYFRA21-1)、TFA是疗效的影响因素(P<0.05)。结论ECOG PS、胸腔积液、LDH可能是TFA发生的影响因素,TFA可能是免疫治疗疗效的影响因素,接受免疫治疗后发生TFA的晚期NSCLC患者可能有更好的疗效。Background and objective Thyroid function abnormality(TFA)is one of the common adverse reac-tions in patients with advanced non-small cell lung cancer(NSCLC)treated with immunotherapy,but the risk factors of TFA and its relationship with efficacy are not completely clear.The purpose of this study was to explore the risk factors of TFA and its relationship with efficacy in patients with advanced NSCLC after immunotherapy.Methods The general clinical data of 200 patients with advanced NSCLC in The First Affiliated Hospital of Zhengzhou University from July 1,2019 to June 31,2021 were collected and analyzed retrospectively.χ²test and multivariate Logistic regression were used to explore the risk factors of TFA.Kaplan-Meier curve was drawn and Log-rank test was used for comparison between groups.Univariate and multivariate Cox analysis was used to explore the efficacy factors.Results A total of 86(43.0%)patients developed TFA.Logistic regression analysis showed that Eastern Cooperative Oncology Group Performance Status(ECOG PS),pleural effusion and lactic dehy-drogenase(LDH)were factors influencing TFA(P<0.05).Compared with normal thyroid function group,the median progres-sion-free survival(PFS)of patients in the TFA group was significantly longer(19.0 months vs 6.3 months,P<0.001),and the objective response rate(ORR)(65.1%vs 28.9%,P=0.020)and disease control rate(DCR)(100.0%vs 92.1%,P=0.020)of the TFA group were better than those of the normal thyroid function group.Cox regression analysis showed that ECOG PS,LDH,cytokeratin 19 fragment(CYFRA21-1)and TFA were factors influencing prognosis(P<0.05).Conclusion ECOG PS,pleural effusion and LDH may be risk factors affecting the occurrence of TFA and TFA may be a predictor of the efficacy of immuno-therapy.Patients with advanced NSCLC who have TFA after immunotherapy may obtain better efficacy.

关 键 词：肺肿瘤 免疫检查点抑制剂 免疫相关不良事件 甲状腺功能 疗效 

分 类 号：R73[医药卫生—肿瘤]