衍生NLR作为进展期非小细胞肺癌免疫治疗反应预测性生物标志物的价值研究  

Value of derived NLR as a predictive biomarker for immunotherapy response in advanced non-small cell lung cancer

作　　者：张蕾[1] 钱震东 吴征斌 王静静 ZHANG Lei;QIAN Zhendong;WU Zhengbin;WANG Jingjing(Department of Respiratory and Critical Care Medicine,Tongling Municipal Hospital/Tongling Hospital Affiliated to Wannan Medical College,Tongling,Anhui 244000,China)

机构地区：[1]铜陵市立医院/皖南医学院附属铜陵医院呼吸与危重症医学科,安徽铜陵244000

出　　处：《国际检验医学杂志》2024年第12期1474-1481,共8页International Journal of Laboratory Medicine

基　　金：铜陵市科技计划项目(20200203043)。

摘　　要：目的探讨衍生中性粒细胞与淋巴细胞比值(dNLR)作为进展期非小细胞肺癌(NSCLC)免疫治疗反应的预测性生物标志物的价值。方法选取2018年8月至2019年12月于该院接受基于抗程序性死亡受体(PD-1)联合治疗的92例进展期NSCLC患者为研究对象。在进展期NSCLC患者免疫治疗前24 h内采集外周血,检测全血细胞计数,计算dNLR。采用PD-1抑制剂或联合方案治疗进展期NSCLC患者,并通过客观缓解率(ORR)和疾病控制率(DCR)评估免疫治疗反应。采用受试者工作特征(ROC)曲线分析dNLR对进展期NSCLC诊断和免疫治疗反应的预测价值,采用多因素Logistic回归模型分析dNLR与进展期NSCLC免疫治疗反应的关系,采用Kaplan-Meier生存曲线和Log-Rank检验分析低dNLR组和高dNLR组的总生存期(OS)、无进展生存期(PFS)和疾病特异性生存期(DSS)。结果进展期NSCLC患者接受免疫治疗后,ORR、DCR分别为32.61%、65.22%,PFS、OS分别为17.0(8.5,25.5)、24.0(12.7,36.1)个月,DCR组dNLR低于非DCR组(P<0.001),ORR组dNLR低于非ORR组(P<0.001)。dNLR预测DCR或ORR的曲线下面积分别为0.897(95%CI 0.829~0.965)和0.874(95%CI 0.795~0.953)。多因素Logistic回归分析显示,dNLR≥2.28者免疫治疗无反应风险增加,进一步校正客观混杂因素后,这种独立关系仍然存在(P<0.05)。生存曲线结果表明,高dNLR患者PFS、OS和DSS明显更短(P<0.05)。多因素Cox回归分析结果显示,高dNLR是进展期NSCLC患者预后不良的独立影响因素(P<0.05)。结论高dNLR的进展期NSCLC患者更难以从免疫治疗中获益,且预后更差。dNLR有希望作为进展期NSCLC免疫治疗反应的预测性生物标志物。Objective To investigate the value of derived neutrophil to lymphocyte ratio(dNLR)as a predictive biomarker for immunotherapy response in advanced non-small cell lung cancer(NSCLC).Methods A total of 92 patients with advanced NSCLC who received anti-programmed cell death receptor(PD-1)combined therapy in the hospital from August 2018 to December 2019 were selected as the research objects.Peripheral blood samples were collected within 24 h before immunotherapy,complete blood cell count was measured,and dNLR was calculated.Patients with advanced NSCLC were treated with PD-1 inhibitors or combination regimens,and the response to immunotherapy was evaluated by objective response rate(ORR)and disease control rate(DCR).The receiver operating characteristic(ROC)curve was used to analyze the predictive value of dNLR for the diagnosis and response to immunotherapy in advanced NSCLC.Multivariate Logistic regression model was used to analyze the relationship between dNLR and immunotherapy response in advanced NSCLC.Kaplan-Meier survival curve and Log-Rank test were used to analyze the overall survival(OS),progression-free survival(PFS)and disease-specific survival(DSS)of the low dNLR group and the high dNLR group.Results The ORR and DCR of advanced NSCLC patients after immunotherapy were 32.61%and 65.22%,respectively,and the PFS and OS were 17.0(8.5,25.5)and 24.0(12.7,36.1)months,respectively.The dNLR of DCR group was lower than that of non-DCR group(P<0.001).The dNLR of ORR group was lower than that of non-ORR group(P<0.001).The area under the curve of dNLR for predicting DCR or ORR was 0.897(95%CI 0.829-0.965)and 0.874(95%CI 0.795-0.953),respectively.Multivariate Logistic regression analysis showed that dNLR≥2.28 increased the risk of non-response to immunotherapy,and this independent relationship still existed after further adjustment for objective confounding factors(P<0.05).Survival curve results showed that patients with high dNLR had significantly shorter PFS,OS,and DSS(P<0.05).Multivariate Cox regression analysis

关 键 词：衍生中性粒细胞与淋巴细胞比值 进展期非小细胞肺癌 免疫治疗反应 

分 类 号：R734.5[医药卫生—肿瘤]