血清TMB水平检测对恶性肿瘤免疫治疗疗效的预测作用分析  

Analysis of the predictive effect of serum TMB level detection on immunotherapy for malignant tumors

作　　者：黄听雨 陈国荣[1] 李君艳[1] 张宪朝 HUANG Ting-yu;CHEN Guo-rong;LI Jun-yan(Second Department of Oncology,the Third Affiliated Hospital of Xinxiang Medical College,Xinxiang 453000,China)

机构地区：[1]新乡医学院第三附属医院肿瘤内二科,453000

出　　处：《中国实用医药》2024年第7期37-41,共5页China Practical Medicine

摘　　要：目的通过检测恶性肿瘤患者血清中肿瘤突变负荷(TMB)水平,分析TMB水平与恶性肿瘤患者免疫治疗疗效的关系,为肿瘤患者的免疫治疗疗效评价提供理论依据。方法46例经细胞病理学(胸腔积液、腹腔积液等)或组织病理学(内镜活检、经皮穿刺活检、转移灶穿刺活检等)明确诊断为恶性肿瘤的患者,均接受二代测序(NGS)检测,并接受免疫单药治疗或免疫联合化疗。分析患者的临床特征,比较不同性别、TNM分期、淋巴结转移情况、用药情况、治疗方式、TMB水平患者的疗效;采用有序Logistic回归模型分析各变量对疗效的影响及不同年龄患者TMB水平对疗效的影响因素。结果不同性别、淋巴结转移情况及治疗方式患者的治疗效果比较,差异无统计学意义(P>0.05)。TNM分期Ⅲ期16例,其中进展(PD)1例(6.3%)、稳定(SD)2例(12.5%)、部分缓解(PR)13例(81.3%),Ⅳ期30例,其中PD 6例(20.0%)、SD 18例(60.0%)、PR 6例(20.0%);一线用药治疗中,PD 1例(4.2%)、SD 6例(25.0%)、PR 17例(70.8%),二三线药治疗中,PD 6例(27.3%)、SD 14例(63.6%)、PR 2例(9.1%);PD患者的TMB水平为(2.48±3.32)mut/Mb、SD患者的TMB水平为(3.23±2.96)mut/Mb、PR患者的TMB水平为(11.95±6.69)mut/Mb。不同TNM分期及用药情况、TMB水平患者的治疗效果比较,差异有统计学意义(P<0.05)。采用有序Logistic回归模型,以疗效为因变量,具体有序Logistic回归模型结果显示:TMB水平对疗效存在显著正向预测作用(B=0.339,P<0.05),说明TMB水平越高,对疗效越促进;TNM分期对疗效存在显著正向预测作用(B=2.660,P<0.05),分期Ⅲ期的疗效显著高于Ⅳ期。一线用药对疗效存在显著正向预测作用(B=3.622,P<0.05);淋巴结转移对疗效不存在显著预测作用(B=-0.859,P>0.05);免疫联合化疗及免疫单药对疗效不存在著预测作用(B=-0.731、-2.299,P>0.05),说明治疗方式对疗效无显著改善作用。Logistic回归分析显示:年龄≥60岁患者,TMB水平Objective By detecting the level of tumor mutation load(TMB)in the serum of patients with malignant tumors,and analyzing the relationship between the level of TMB and the efficacy of immunotherapy in patients with malignant tumors,so as to provide a theoretical basis for the evaluation of the efficacy of immunotherapy in tumor patients.Methods 46 patients with malignant tumors clearly diagnosed by cytopathology(pleural effusion,abdominal effusion,etc.)or histopathology(endoscopic biopsy,percutaneous puncture biopsy,metastatic lesion puncture biopsy,etc.)were tested by next-generation sequencing(NGS)and received either immunotherapy alone or immunotherapy combined with chemotherapy.The clinical characteristics of the patients were analyzed to compare the efficacy of patients with different genders,TNM stages,lymph node metastases,drug use,treatment modalities,and TMB levels,and ordered Logistic regression model was used to analyze the influence of each variable on the efficacy and the influence of TMB level on efficacy in patients of different ages.Results There was no significant difference in the therapeutic effect of patients with different gender,lymph node metastasis and treatment modalities(P>0.05).There were 16 patients with TNM stageⅢ,including 1 patient(6.3%)with progressive disease(PD),2 patients(12.5%)with stable disease(SD),13 patients(81.3%)with partial remission(PR);there were 30 cases in stageⅣ,including 6 cases(20.0%)of PD,18 cases(60.0%)of SD,and 6 cases(20.0%)of PR.In first-line drug treatment,there were 1 case(4.2%)of PD,6 cases(25.0%)of SD,17 cases(70.8%)of PR,and in second-and third-line drug treatment,there were 6 cases of PD(27.3%),14 cases of SD(63.6%),and 2 cases of PR(9.1%).The TMB level was(2.48±3.32)mut/Mb in PD patients,(3.23±2.96)mut/Mb in SD patients,and(11.95±6.69)mut/Mb in PR patients.The treatment effect of patients with different TNM stage,medications and TMB level were compared,and the difference was statistically significant(P<0.05).The ordered Logistic regression model

关 键 词：恶性肿瘤 肿瘤突变负荷 免疫治疗 疗效预测 

分 类 号：R730.51[医药卫生—肿瘤]