衍生中性粒细胞与淋巴细胞比值在接受一线阿替利珠单抗免疫治疗联合化疗的广泛期小细胞肺癌患者预后预测中的价值  

Value of derived neutrophil-to-lymphocyte ratio in predicting prognosis of extensive-stage small cell lung cancer patients treated with the first-line atezolizumab immunotherapy and chemotherapy

作　　者：郭晋锋 侯庆[2] 姚宁宁 孙博辰 梁玉[2] 曹欣 曹建忠[2] Guo Jinfeng;Hou Qing;Yao Ningning;Sun Bochen;Liang Yu;Cao Xin;Cao Jianzhong(Department of Hospital Office,Shanxi Province Cancer Hospital,Shanxi Hospital Affiliated to Cancer Hospital,Chinese Academy of Medical Sciences,Cancer Hospital Affiliated to Shanxi Medical University,Taiyuan 030013,China;Department of Radiotherapy,Shanxi Province Cancer Hospital,Shanxi Hospital Affiliated to Cancer Hospital,Chinese Academy of Medical Sciences,Cancer Hospital Affiliated to Shanxi Medical University,Taiyuan 030013,China)

机构地区：[1]山西省肿瘤医院、中国医学科学院肿瘤医院山西医院、山西医科大学附属肿瘤医院医院办公室,太原030013 [2]山西省肿瘤医院、中国医学科学院肿瘤医院、山西医院山西医科大学附属肿瘤医院放射治疗科,太原030013

出　　处：《肿瘤研究与临床》2023年第9期658-663,共6页Cancer Research and Clinic

基　　金：山西省应用基础研究计划(20210302124598);山西省留学回国人才科研活动择优资助项目([2019]1176号);山西省回国留学人员科研资助项目([2022]210号);山西省"四个一批"科技兴医创新计划([2022]37号)。

摘　　要：目的探讨衍生中性粒细胞与淋巴细胞比值(dNLR)在接受一线阿替利珠单抗免疫治疗联合化疗的广泛期小细胞肺癌(ES-SCLC)患者预后预测中的价值。方法从数据共享平台Project Data Sphere收集全球多中心Ⅱ期前瞻性研究NCT03041311中2017年2月至2022年2月接受一线阿替利珠单抗免疫治疗联合化疗的53例ES-SCLC患者的临床资料和实验室检查数据。采用Contal-O'Quigley方法计算判断患者总生存(OS)的基线dNLR的最佳临界值,将≥最佳临界值定义为高dNLR,<最佳临界值定义为低dNLR;根据此最佳临界值,判断基线和化疗4个周期后的dNLR水平,并进行动态dNLR分组(低危为基线和化疗4个周期后均为低dNLR;中危为任意一次为高dNLR;高危为两次均为高dNLR)。比较基线高dNLR组与低dNLR组间临床病理特征的差异,采用Kaplan-Merier法绘制OS和无进展生存(PFS)曲线,组间比较采用log-rank检验。采用单因素Cox比例风险模型分析OS、PFS的影响因素。应用时间依赖受试者工作特征(ROC)曲线评估基线dNLR分组和动态dNLR分组对接受一线阿替利珠单抗免疫治疗联合化疗的ES-SCLC患者1年OS率的预测价值。结果53例患者中,男性34例(64.20%),女性19例(35.80%);<65岁27例(50.90%),≥65岁26例(49.10%)。基线dNLR判断OS的最佳临界值为1.79。基线低dNLR组17例,高dNLR组36例;高dNLR组血清乳酸脱氢酶(LDH)升高患者比例高于低dNLR组[58.33%(21/36)比17.65%(3/17),χ^(2)=7.72,P=0.005];基线高、低dNLR组的1年OS率分别为44.0%、81.9%,1年PFS率分别为2.5%、17.6%,两组间OS和PFS差异均有统计学意义(均P<0.05)。有完整动态dNLR资料患者38例,其中低危、中危和高危患者分别有9、19、10例,1年OS率分别为90.0%、67.5%、33.3%,3组OS比较差异有统计学意义(P=0.011)。单因素Cox回归分析显示,基线dNLR(低dNLR比高dNLR)是患者OS(HR=0.163,95%CI 0.057~0.469,P=0.001)和PFS(HR=0.505,95%CI 0.268~0.952,P=0.035)的影响因素。时间依赖RObjectiveTo investigate the value of derived neutrophil-to-lymphocyte ratio(dNLR)in predicting the prognosis of extensive-stage small cell lung cancer(ES-SCLC)patients treated with the first-line atezolizumab immunotherapy and chemotherapy.MethodsFrom the Project Data Sphere platform,the clinical data and laboratory test data of 53 ES-SCLC patients who received the first-line atezolizumab immunotherapy and chemotherapy in the global multicenter phaseⅡprospective study NCT03041311 from February 2017 to February 2022 were collected.The Contal-O'Quigley method was used to calculate the optimal cut-off value of baseline dNLR for determining the overall survival(OS)of patients.The dNLR higher than or equal to the optimal cut-off value was defined as high dNLR,and less than the optimal cut-off value was defined as low dNLR.According to optimal cut-off value,the dNLR levels at baseline and after 4 cycles of chemotherapy were determined,and dynamic dNLR grouping was performed(low risk:low dNLR at baseline and after 4 cycles of chemotherapy;intermediate risk:high dNLR at baseline or after 4 cycles of chemotherapy;high risk:high dNLR at baseline and after 4 cycles of chemotherapy).The differences in clinicopathological features between the baseline high dNLR group and low dNLR group were analyzed.Kaplan-Meier method was used to draw the OS and progression-free survival(PFS)curves,and log-rank test was used to compare the differences between the two groups.Univariate Cox proportional hazards model was used to analyze the influencing factors of OS and PFS.The time-dependent receiver operating characteristic(ROC)curve was used to evaluate the predictive value of baseline dNLR grouping and dynamic dNLR grouping for 1-year OS rate in ES-SCLC patients receiving the first-line atezolizumab immunotherapy and chemotherapy.ResultsAmong the 53 patients,34(64.20%)were male and 19(35.80%)were female;27(50.90%)were<65 years old and 26(49.10%)were≥65 years old.The optimal cut-off value of baseline dNLR for determining the OS was 1.79

关 键 词：小细胞肺癌 衍生中性粒细胞与淋巴细胞比值 免疫治疗 预后 

分 类 号：R734.2[医药卫生—肿瘤]