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中国临床药理学与治疗学 ›› 2024, Vol. 29 ›› Issue (5): 569-575.doi: 10.12092/j.issn.1009-2501.2024.05.012

• 药物治疗学 • 上一篇    下一篇

淋巴细胞/单核细胞比值及其动态变化与PD-1抑制剂治疗晚期非小细胞肺癌的疗效分析

何烨1,王银华1,耿彪2,鲍兴3   

  1. 1芜湖市第二人民医院,放疗科,芜湖  241001,安徽; 2皖南医学院第一附属医院(皖南医学院弋矶山医院),呼吸内科,芜湖  241001,安徽; 3皖南医学院,研究生学院,芜湖  241002,安徽

  • 收稿日期:2023-09-06 修回日期:2023-11-02 出版日期:2024-05-26 发布日期:2024-04-16
  • 作者简介:何烨,男,硕士研究生,主治医师,主要从事肿瘤的靶向与免疫治疗。 E-mail: heye1315@163.com
  • 基金资助:
    2020年安徽省自然科学基金青年项目(2008085QH351)

The relationship between the ratio and dynamic changes of lymphocytes/monocytes and the efficacy of PD-1 inhibitors in the treatment of advanced non-small cell lung cancer

HE Ye1, WANG Yinhua1, GENG Biao2, BAO Xing3   

  1. 1 Department of Radiotherapy, The Second People's Hospital of Wuhu, Wuhu 241001, Anhui, China; 2 Department of Respiratory, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu 241001, Anhui, China; 3 School of Pharmacy, Wannan Medical College, Wuhu 241002, Anhui, China
  • Received:2023-09-06 Revised:2023-11-02 Online:2024-05-26 Published:2024-04-16

摘要:

目的:探讨PD-1抑制剂治疗前外周血淋巴细胞和单核细胞比值(lymphocyte-to-monocytes ratios,LMR)及治疗后的动态变化与PD-1抑制剂治疗晚期非小细胞肺癌患者(non-small cell lung cancer,NSCLC)疗效及预后的关系。方法:回顾性分析芜湖市第二人民医院肿瘤内科、肿瘤放疗科及肿瘤介入科自2019年6月至2022年7月收治的83例晚期NSCLC患者的临床病例资料。收集所有患者治疗前及治疗后的血常规LMR数值,根据ROC曲线计算临界值,并将LMR分为治疗前和治疗后高低两组。分析比较各组患者的客观缓解率(ORR)、疾病控制率(DCR),以及无进展生存期(progression-free survival,PFS)、总生存期(overall survival,OS)的差异,分析LMR值及治疗后的动态变化对PD-1抑制剂治疗NSCLC患者疗效及预后的价值。结果:根据ROC曲线计算LMR临界值为1.8,将LMR分为基线低LMR组(LMRB/S<1.8)、高LMR组(LMRB/S≥1.8)及治疗后低LMR组(LMRafter<1.8)、治疗后高LMR组(LMRafter≥1.8)。治疗前高LMRB/S组免疫治疗后的ORR和DCR均高于低LMRB/S组(P=0.037;P=0.002 5)。治疗前低LMRB/S患者中,在治疗后LMRafter≥1.8组的DCR优于LMRafter<1.8组(P=0.005)。治疗前高LMR患者中,治疗后LMRafter≥1.8组的DCR优于LMRafter<1.8组(P=0.034)。Kaplan- Meier分析显示,治疗前高LMRB/S组的PFS、OS均比低LMRB/S组延长;且在治疗前低LMRB/S组中,治疗后LMRafter≥1.8的患者PFS、OS均比LMRafter<1.8的患者延长(P=0.047;P=0.007)。多因素Cox回归模型分析显示,治疗前高LMRB/S值是影响NSCLC患者PFS和OS的独立危险因素(P=0.006;P=0.033)。结论:免疫治疗前患者高LMR值可能提高PD-1抑制剂的疗效,改善患者预后,延长生存时间;且治疗后LMR值的升高可能会增加治疗前低LMR患者的疗效,改善患者的预后。

关键词: 淋巴细胞和单核细胞比值, 非小细胞肺癌, PD-1抑制剂, 生物标志物

Abstract:

AIM: To investigate the relationship between the dynamic changes of Lymphocyte-to-monocytes ratios (LMR) before PD-1 inhibitor treatment and the efficacy and prognosis of PD-1 inhibitor treatment in patients with advanced non-small cell lung cancer (NSCLC). METHODS: The clinical case data of 83 patients with advanced non-small cell lung cancer admitted to the Cancer Hospital of Wuhu Second People's Hospital from June 2019 to July 2022 were retrospectively analyzed. The routine blood LMR values of all patients before and after treatment were collected, the cut-off value was calculated according to the ROC curve, and the LMR was divided into two groups: high and low before treatment and after treatment. The differences of ORR, DCR, PFS and OS among the patients in each group were analyzed and compared, and the value of LMR value and dynamic changes after treatment on the efficacy and prognosis of patients with PD-1 inhibitors in the treatment of NSCLC patients was analyzed. RESULTS: According to the ROC curve, the critical value of LMR was 1.8, and the LMR was divided into the low LMR group at baseline (LMRB/S<1.8),the high LMR group at baseline (LMRB/S≥1.8) and the low LMR group after treatment (LMRafter<1.8) and the high LMR group after treatment (LMRafter≥1.8). The ORR and DCR after immunotherapy in the high LMRB/S group were higher than those in the low LMRB/S group (P=0.037; P=0.002 5). Among the patients with low LMRB/S before treatment, the DCR of the LMRafter≥1.8 group was better than that of the LMRafter<1.8 group after treatment (P=0.005). Among the patients with high LMR before treatment, the DCR of the LMRafter≥1.8 group was better than that of the LMRafter<1.8 group (P=0.034). Kaplan-Meier analysis showed that PFS and OS were longer in the high LMRB/S group than in the low LMRB/S group before treatment. In the low LMRB/S group before treatment, PFS and OS were longer in patients with LMRafter≥1.8 than those with LMRafter<1.8 (P=0.047; P=0.007). Multivariate Cox regression model analysis showed that high LMRB/S value before treatment was an independent risk factor for PFS and OS in NSCLC patients (P=0.006; P=0.033). CONCLUSION: High LMR value of patients before immunotherapy may improve the efficacy of PD-1 inhibitors, improve the prognosis of patients, and prolong the survival time. Moreover, the increase of LMR value after treatment may increase the efficacy of patients with low LMR before treatment and improve the prognosis of patients.

Key words: lymphocyte-to-monocytes ratios, non-small cell lung cancer, PD-1 inhibitor, biomarker

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