摘要
目的探讨在接受免疫检查点抑制剂(ICIs)治疗前绝对淋巴细胞计数(ALC)及其他血液炎症标志物在广泛期小细胞肺癌(ES-SCLC)患者预后中的意义。方法回顾性分析2018-10-25-2020-08-20在山东省肿瘤医院首次接受ICIs治疗的65例ES-SCLC患者的临床资料。根据治疗前血常规结果收集并计算ALC及其他血液炎症标志物水平。衍生中性粒细胞/淋巴细胞比率(dNLR)和乳酸脱氢酶(LDH)的截断值分别为3和245 U/L,其余连续变量均以中位数作为截断值,并根据截断值将所有连续变量分为高低2组。使用Cox比例风险回归模型进行单因素和多因素分析。采用Kaplan-Meier法绘制生存曲线,用Log-rank检验比较组间生存率。结果中位随访时间为18.0(95%CI:16.2~19.7)个月,中位无进展生存期(PFS)为5.1(95%CI:3.5~6.6)个月。单因素分析结果显示,吸烟、ALC、绝对血小板计数(APC)和淋巴细胞/单核细胞比率(LMR)是影响患者PFS的可能因素,均P<0.05。向前步进似然比法结果显示,ALC是影响患者PFS的因素,HR=0.45,95%CI:0.25~0.79,P=0.006;进入法结果显示,如果同时考虑吸烟、APC、LMR和ALC的作用,4个因素无统计学意义,均P>0.05。Kaplan-Meier生存分析结果显示,与高ALC组相比,低ALC组患者PFS较短(中位PFS,6.2 vs 4.1个月),P=0.005。结论接受ICIs治疗前低ALC与ES-SCLC患者的不良预后相关联,可能有助于筛选合适患者和进行疗效预测。
Objective To investigate the prognostic significance of absolute lymphocyte count(ALC)and other blood inflammatory markers in patients with extensive-stage small cell lung cancer(ES-SCLC)before receiving immune checkpoint inhibitors(ICIs).Methods The clinical data of 65 ES-SCLC patients who received ICIs for the first time in Shandong Cancer Hospital from 2018-10-25-2020-08-20 were retrospectively analyzed.The levels of ALC and other blood inflammatory markers were collected and calculated according to the pre-treatment blood routine results.The cutoff values for derived neutrophil to 1 ymphocyte ratio(dNLR)and lactate dehydrogenase(LDH)were 3 and 245 U/L,respectively.And the remaining continuous variables were taken as the median cutoff value,and all the continuous variables were divided into high and low groups.Univariate and multivariate analyses were performed using Cox proportional hazards regression models.Survival curves were drawn using the Kaplan-Meier method,and the survival rates between groups were compared using the Log-rank test.Results The median follow-up time was 18.0(95%CI:16.2-19.7)months,and the median progression-free survival(PFS)was 5.1(95%CI:3.5-6.6)months.Univariate analysis showed that smoking,ALC,absolute platelet count(APC)and lymphocyte to monocyte ratio(LMR)were the possible factors affecting the PFS of patients(all P<0.05).The results of the forward step likelihood ratio method showed that ALC was a factor affecting the PFS of patients(HR=0.45,95%CI:0.25-0.79,P=0.006).The results of the entry method showed that if the effects of smoking,APC,LMR and ALC were considered together,the four factors were not statistically significant(all P>0.05).Kaplan-Meier survival analysis showed that compared with the high ALC group,patients in the low ALC group had shorter PFS(median PFS,6.2 vs 4.1 months,P=0.005).Conclusion Low ALC before ICIs treatment is associated with poor prognosis in ES-SCLC patients,which may help to select suitable patients and predict efficacy.
作者
尹莹
李莉
刘宁
于清溪
袁双虎
YIN Ying;LI Li;LIU Ning;YU Qing-xi;YUAN Shuang-hu(School of Clinical Medicine,Southwest Medical University,Luzhou 646000,China;Department of Radiotherapy,Shandong Cancer Research Institute(Shandong Cancer Hospital),Shandong First Medical University(Shandong Academy of Medical Sciences),Jinan 250117,China)
出处
《中华肿瘤防治杂志》
CAS
北大核心
2022年第3期193-197,共5页
Chinese Journal of Cancer Prevention and Treatment
基金
国家自然科学基金(NSFC81872475,NSFC82073345)
济南市临床医学科技创新计划(202019060)
关键词
广泛期小细胞肺癌
免疫检查点抑制剂
绝对淋巴细胞计数
预后
extensive-stage small cell lung cancer
immune checkpoint inhibitors
absolute lymphocyte counts
prognosis
作者简介
第一作者:尹莹,女,四川资阳人,硕士,主要从事胸部肿瘤放射治疗的临床研究工作。E-mail:yinying232322@163.com;通讯作者:袁双虎,男,河北衡水人,博士,主任医师,博士生导师,主要从事胸部肿瘤放射治疗的临床研究工作。E-mail:yuanshuanghu@sina.com
