外周血NLR、PLR、CEA、NSE和CYFRA21-1对晚期非小细胞肺癌免疫疗效的预测价值研究  

Predictive value of NLR,PLR,CEA,NSE and CYFRA21-1in peripheral blood for immunotherapy efficacy of advanced non-small cell lung cancer

作　　者：候梦圆 李春阳 沙晓雨 高勇 刘艳坤[3] 王志武[2] HOU Mengyuan;LI Chunyang;SHA Xiaoyu;GAO Yong;LIU Yankun;Wang Zhiwu(School of Graduate,North China University of Science and Technology,Tangshan 063200,China)

机构地区：[1]华北理工大学研究生学院,河北省唐山市063200 [2]唐山市人民医院放化二科 [3]唐山市人民医院医学分子诊断科,河北省分子肿瘤学重点实验室,唐山市精准检测重点实验室

出　　处：《中国煤炭工业医学杂志》2024年第4期414-425,共12页Chinese Journal of Coal Industry Medicine

基　　金：河北省第六批省级科技计划项目(编号:20377758D)。

摘　　要：目的探讨中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)、癌胚抗原(CEA)、神经元特异性烯醇化酶(NSE)、细胞角蛋白19片段21-1(CYFRA21-1)对晚期非小细胞肺癌(NSCLC)患者免疫治疗两周期疗效和最佳疗效的预测价值。方法回顾性纳入2022年1月—2023年6月该院以免疫治疗为基础治疗的162例晚期NSCLC患者,收集患者的临床病理特征、基线2周内的外周血(NLR0和PLR0计数、CEA0、NSE0和CYFRA21-10水平)和第2周期免疫治疗前2周内的外周血(NLR2和PLR2计数、CEA2、NSE2和CYFRA21-12水平)。采用RECIST1.1评估晚期NSCLC患者免疫治疗两个周期的疗效和最佳疗效,χ^(2)检验或Fisher精确检验分析5个外周血指标与晚期NSCLC患者免疫治疗两周期疗效和最佳疗效的关系,多因素Logistic回归分析晚期NSCLC患者免疫治疗两周期疗效和最佳疗效的独立影响因素。结果年龄(P=0.024)和病理类型(P=0.038)与晚期NSCLC患者免疫治疗两周期疗效之间差异有统计学意义。NLR2、PLR2、CEA2、NSE2、CYFRA21-12预测免疫疗效的能力较NLR0、PLR0、CEA0、NSE0、CYFRA21-10和ΔNLR、ΔPLR、ΔCEA、ΔNSE、ΔCYFRA21-1强,五个指标(NLR2、PLR2、CEA2、NSE2和CYFRA21-12)串联联合预测的效能更强。低水平NLR2(<2.56)、PLR2(<148.53)、CEA2(<2.65ng/ml)、NSE2(<17.73ng/ml)和CYFRA21-12(<2.68ng/ml)的晚期NSCLC患者免疫治疗两周期疗效较好(P<0.05),低水平NLR2(<2.56)、PLR2(<141.93)、CEA2(<21.83ng/ml)、NSE2(<10.00ng/ml)和CYFRA21-12(<2.99ng/ml)的晚期NSCLC患者免疫治疗最佳疗效较好(P<0.05)。多因素Logistic回归分析显示,年龄(OR=3.490,95%CI:1.419~8.584,P=0.007)、PLR2(OR=0.346,95%CI:0.141~0.845,P=0.020)和CYFRA21-12(OR=0.305,95%CI:0.119~0.779,P=0.013)为晚期NSCLC患者免疫治疗两周期疗效的独立影响因素。PLR2(OR=0.314,95%CI:0.149~0.660,P=0.002)、CEA2(OR=0.330,95%CI:0.112~0.972,P=0.044)和CYFRA21-12(OR=0.410,95%CI:0.189~0.887,P=0.024)为晚期NSCLC患者免疫治疗最佳�Objective To explore the predictive value of neutrophil-to-lymPhocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR),carcinoembryonic antigen(CEA),neuron-specific enolase(NSE),cytokeratin 19fragment 21-1(CYFRA21-1)and other clinicopathological features for efficacy of the two cycles and the optimal of immunotherapy of advanced non-small cell lung cancer(NSCLC)patients.Methods The retrospective study was enrolled 162advanced NSCLC patients who received immunotherapy as a basic treatment in Tangshan People's Hospital from January 2022to June 2023.The clinicopathological features,peripheral blood(NLR0and PLR0counts,CEA0,NSE0and CYFRA21-10levels)within 2weeks at baseline,and peripheral blood(NLR0and PLR0counts,CEA0,NSE0and CYFRA21-10levels)within 2weeks before the second cycles of immunotherapy were collected.The two-cycle-efficacy and the optimal efficacy of immunotherapy of advanced NSCLC patients were evaluated according to RECIST 1.1.Chi-square test or Fisher exact test was used to analyze the relationship between the five peripheral blood indexes of two-cycle-efficacy and the optimal efficacy of immunotherapy.Multivariate Logistic regression was implied to analyze the independent influencing factors of the two-cycle-efficacy and the optimal efficacy of immunotherapy.Results The age(P=0.024)and pathologic type(P=0.038)were associated with two-cycle-efficacy of the immunotherapy of advanced NSCLC patients.The predicting immunotherapy efficacy of NLR2,PLR2,CEA2,NSE2and CYFRA21-12were superior to predicting immunotherapy efficacy of NLR0,PLR0,CEA0,NSE0,CYFRA21-10,ΔNLR,ΔPLR,ΔCEA,ΔNSE,andΔCYFRA21-1.The predictive ability of series combination with these five indexes(NLR2,PLR2,CEA2,NSE2and CYFRA21-12)was more effective than each one.Patients of advanced NSCLC with low levels of NLR2(<2.56),PLR2(<148.53),CEA2(<2.65ng/ml),NSE2(<17.73ng/ml)and CYFRA21-12(<2.68ng/ml)showed better response after two cycles of immunotherapy(P<0.05),NSCLC patients with low levels of NLR2(<2.56),PLR2(<141.93),CEA2(<21.83ng/ml),NSE2(<10.00ng

关 键 词：非小细胞肺癌 免疫疗效 外周血 两周期疗效 最佳疗效 

分 类 号：R734.2[医药卫生—肿瘤]