支气管肺泡灌洗液中免疫细胞亚群与晚期非小细胞肺癌一线免疫治疗疗效相关性的分析:一项病例对照研究  

Analysis of the Correlation between Immune Cell Subsets in Bronchoalveolar Lavage Fluid and the Efficacy of First-line Use of Immunotherapy in Advanced Non-small Cell Lung Cancer:A Case-control Study

作　　者：张凯 史亮[1,2] 张同梅 仝丽[1,2] 魏嵩[1,2] 李红霞 Kai ZHANG;Liang SHI;Tongmei ZHANG;Li TONG;Song WEI;Hongxia LI(Department of Medical Oncology,Beijing Tuberculosis&Thoracic Tumor Research Institute/Beijing Chest Hospital,Capital Medical University;Laboratory for Clinical Medicine,Capital Medical University,Beijing 101149,China)

机构地区：[1]北京市结核病胸部肿瘤研究所/首都医科大学附属北京胸科医院肿瘤内科,北京101149 [2]首都医科大学基础临床联合实验室

出　　处：《中国肺癌杂志》2024年第12期894-902,共9页Chinese Journal of Lung Cancer

基　　金：北京市结核病胸部肿瘤研究所能力提升项目;北京市属医学科研院所公益发展改革试点项目(No.JYY2023-14、No.JYY2023-15);北京微爱公益基金会-菁英科研基金(No.JYKY2024-0100307015)资助。

摘　　要：背景与目的 免疫治疗已成为晚期非小细胞肺癌(non-small cell lung cancer, NSCLC)患者的标准治疗,但对于接受免疫治疗的晚期NSCLC患者仍缺乏特异性的疗效预测生物标志物,本研究通过探索支气管肺泡灌洗液(bronchoalveolar lavage fluid, BALF)中淋巴细胞亚群情况,并结合NSCLC患者的临床和实验室检查指标,探索潜在的免疫治疗相关性生物标志物。方法 回顾性分析2020年3月至2022年11月在首都医科大学附属北京胸科医院进行电子支气管镜检查并接受一线免疫治疗的82例局部晚期或晚期NSCLC患者的资料,通过Logistic回归和随机森林模型评估BALF中免疫细胞亚群与疗效的关联,并验证预测模型的敏感性。结果 入组患者均接受一线免疫治疗,按照临床诊疗规范进行疗效评价:纳入的82例患者中,48例达到客观缓解,34例未达到。对采集的相关指标与临床治疗最佳疗效之间的关系进行分析,结果显示BALF中的总淋巴细胞百分比升高与较好的免疫治疗疗效有关(P<0.05),BALF中的辅助性T细胞百分比的升高与免疫治疗的疗效不佳有关(P<0.05)。结论 BALF中总淋巴细胞和辅助性T细胞比例可作为晚期NSCLC免疫治疗疗效的重要预测指标,联合其他指标构建的多变量模型可以进一步提高预测准确性。Background and objective Immunotherapy has been a standard treatment for the patients with advanced non-small cell lung cancer(NSCLC),however,reliable biomarkers for predicting the response remain unclear.This study explores the subpopulations of lymphocytes in bronchoalveolar lavage fluid(BALF)and combines clinical and laboratory examination indicators of NSCLC patients to identify potential biomarkers related to immunotherapy.Methods A retrospective analysis was conducted on 82 patients with locally advanced or metastatic NSCLC who underwent electronic bronchoscopy and received first-line immunotherapy at Beijing Chest Hospital,Capital Medical University between March 2020 and November 2022.Logistic regression and random forest models were employed to determine the correlation between immune cell subsets in BALF and response of immunotherapy.The predictive value was validated by the model.Results All patients enrolled received first-line immunotherapy,and the efficacy was evaluated according to clinical guidelines:among the 82 patients included,48 patients got objective response and the other 34 did not achieve.The relationship between collected indicators and the best clinical treatment response was analyzed.The result shows that a higher percentage of total lymphocytes in BALF was associated with good response of first-line immunotherapy(P<0.05),while a higher percentage of T helper cells in BALF was associated with poor prognosis(P<0.05).Conclusion The proportions of total lymphocytes and T helper cells in BALF could be used as predictive biomarkers for first-line immunotherapy in late stage NSCLC.A multivariable model im-proves predictive accuracy.

关 键 词：肺肿瘤 肺泡灌洗液 免疫治疗 疗效预测 

分 类 号：R73[医药卫生—肿瘤]