基线中性粒细胞与淋巴细胞比值对晚期肿瘤免疫治疗早期疗效的预测价值  

Predictive value of baseline neutrophil-to-lymphocyte ratio for early efficacy of immunotherapy in advanced cancer patients

作　　者：张文颖[1] 袁海花[1] 胡晓华 王炯轶[1] 刘峰[1] ZHANG Wen-ying;YUAN Hai-hua;HU Xiao-hua;WANG Jiong-yi;LIU Feng(Department of Oncology,Shanghai Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 201999,China)

机构地区：[1]上海交通大学医学院附属第九人民医院肿瘤科,上海201999

出　　处：《中国临床医学》2023年第4期647-651,共5页Chinese Journal of Clinical Medicine

基　　金：国家自然科学基金(81572796).

摘　　要：目的探讨中性粒细胞与淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)对无法检测PD-L1表达水平、肿瘤突变负荷(tumor mutation burden,TMB)、微卫星高度不稳定(microsatellite instability-high,MSI-H)等晚期肿瘤患者免疫治疗早期疗效的预测价值。方法回顾性选择2020年1月至2021年12月上海交通大学医学院附属第九人民医院接受PD-1单抗治疗的48例无法检测PD-L1表达水平、TMB、MSI-H等的晚期肿瘤患者,采用logistic多因素分析评估患者年龄、性别、原发肿瘤部位、免疫治疗方式及NLR与早期治疗疗效的相关性。通过ROC曲线分析基线NLR预测疾病控制状态的最佳截断值。根据NLR最佳截断值,将患者分为高NLR组(n=28)和低NLR组(n=20),比较两组免疫治疗早期疗效。结果Logistic多因素分析显示,基线NLR与免疫治疗早期疗效独立相关(P=0.009)。NLR预测免疫治疗早期疗效的最佳截断值为3.54。低NLR组和高NLR组患者的客观缓解率分别为20.0%和7.1%(P=0.003),疾病控制率分别为85.0%和35.7%(P=0.001)。结论在晚期肿瘤患者中,基线NLR对PD-1单抗早期疗效具有潜在预测价值。Objective To explore the predictive value of neutrophil-to-lymphocyte ratio(NLR)on the therapeutic effects of immunotherapy in advanced cancer patients who can not detect PD-L1 expression levels,tumor mutation burden(TMB),and microsatellite instability-high(MSI-H).Methods The data of 48 advanced cancer patients treated with PD-1 antibodies but cannot detect PD-L1,TMB,MSI-H in Shanghai Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine from January 2020 to December 2021 were collected.Logistic regression was used to analyze the correlation between age,gender,primary tumor site,type of anti-PD-1 therapy,NLR and early efficacy.The optimal cut-off value of NLR predicting the disease control status was obtained by ROC curve.Patients were divided into NLR high-level group(n=28)and NLR low-level group(n=20)based on cutoff value of NLR.The early treatment efficacy between the two groups were compared.Results Multivariate logistic regression analysis showed a significant correlation between baseline NLR and early treatment efficacy(P=0.009).The optimal cut-off value of NLR for DCR was 3.54.Objective response rate(ORR)was 20.0%and 7.1%(P=0.003)and disease control rate(DCR)was 85.0%and 35.7%(P=0.001)in patients of the low NLR group and high NLR group,respectively.Conclusions Baseline NLR has potential predictive value for early efficacy in advanced cancer patients treated with PD-1 monoclonal antibody therapy.

关 键 词：中性粒细胞/淋巴细胞比值 免疫检查点抑制剂 恶性肿瘤 疾病控制率 

分 类 号：R730.3[医药卫生—肿瘤]