中性粒细胞和淋巴细胞比值与晚期/复发胃癌一线免疫联合化疗疗效的关联分析  

Correlation analysis of neutrophil-to-lymphocyte ratio and the efficacy of advanced/recurrent gastric cancer treated with first-line immunotherapy combined with chemotherapy

作　　者：王春冰 牟妍希 马明瑞 王薇薇 喻伟 彭虎 WANG Chunbing;MOU Yanxi;MA Mingrui;WANG Weiwei;YU Wei;PENG Hu(Medical Oncology,National Cancer Center,National Clinical Research Center for Cancer,Cancer Hospital&Shenzhen Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Shenzhen 518116,China)

机构地区：[1]国家癌症中心·国家肿瘤临床医学研究中心·中国医学科学院北京协和医学院肿瘤医院深圳医院肿瘤内科,广东深圳518116

出　　处：《中华肿瘤防治杂志》2023年第18期1116-1120,共5页Chinese Journal of Cancer Prevention and Treatment

基　　金：深圳市科创委基础研究面上项目(JCYJ20210324134413038)。

摘　　要：目的探讨外周血中性粒细胞与淋巴细胞比值(NLR)能否预测晚期/复发胃癌患者一线免疫联合化疗的近期客观疗效。方法收集2019-09-01-2022-03-31中国医学科学院肿瘤医院深圳医院内科,以免疫治疗联合化疗作为一线治疗,且具备完整临床病理资料及近期随访结果的晚期/复发胃癌58例患者临床资料。采用受试者工作特征曲线(ROC)确定化疗前NLR临界值为2.63,将患者分为NLR≤2.63(40例)和NLR>2.63组(18例),分析NLR水平之间的关联性,并对其近期客观疗效进行分析。采用实体瘤疗效评价标准(RECIST)1.1评估疗效。结果在58例患者中,NLR≤2.63和NLR>2.63组的性别、年龄、ECOG、肿瘤部位、分化程度、转移数目、TNM分期和阳性联合分数(CPS)差异无统计学意义,均P>0.05;但浸润深度差异有统计学意义,χ^(2)=13.850,P<0.001。NLR≤2.63组疾病控制率(DCR)为82.5%(33/40),优于NLR>2.63组的50.0%(9/18),χ^(2)=6.564,P=0.010。多因素分析结果显示,NLR值是影响胃癌患者预后的独立因素,HR=5.710,95.0%CI为1.282~25.433,P<0.05。结论基线NLR可作为预测和评价晚期/复发胃癌免疫治疗近期客观疗效的有价值指标,高NLR值提示预后较差。Objective To explore the significance of peripheral blood neutrophil-to-lymphocyte ratio(NLR)in evaluating the short-term effects of patients with advanced/recurrent gastric cancer(GC)treated with first-line immunotherapy combined with chemotherapy.Methods From September 1st 2019 to March 31st 2022,the clinical data of 58 patients with advanced/recurrent GC were collected from Cancer Hospital&Shenzhen Hospital,Chinese Academy of Medical Sciences.These patients were treated with immunotherapy combined with chemotherapy as first-line treatment and had complete clinical and pathological data and recent follow-up results.Receiver operating characteristic(ROC)curve analysis was used to confirm the cut-off value,and patients were stratified into NLR≤2.63(40 patients)and NLR>2.63(18 patients)groups.The correlation between the two groups of different NLR levels and its recent objective efficacy were analyzed.The short-term efficacy was evaluated by RECIST 1.1.Results For the 58 patients,basic characteristics,including gender,age,ECOG,tumor site,differentiation,number of metastatic sites,TNM stage,combined positive score between the two groups had no statistical significance(P>0.05),but there was significant difference in infiltration depth between the two groups(χ^(2)=13.850,P<0.001).Superior disease control rate was achieved in the NLR≤2.63 group(82.5%versus 50.0%,χ^(2)=6.564 P=0.010).Multivariate Cox analysis revealed that NLR was independent prognosis factors for patients with gastric cancer(HR=5.710,95%CI:1.282-25.433,P<0.05).Conclusions Baseline NLR can be used as a valuable indicator for predicting and evaluating the efficacy of chemo-immunotherapy treatment in advanced/recurrent patients with gastric cancer.High NLR value is associated with poor prognosis.

关 键 词：晚期/复发胃癌 化疗 免疫治疗 中性粒细胞/淋巴细胞比值 近期客观疗效 

分 类 号：R735.2[医药卫生—肿瘤]