免疫巩固治疗前NLR、PLR与Ⅲ期老年非小细胞肺癌病人预后的相关性

doi:10.3969/j.issn.1003-9198.2023.11.010

实用老年医学 ›› 2023, Vol. 37 ›› Issue (11): 1120-1124.doi: 10.3969/j.issn.1003-9198.2023.11.010

免疫巩固治疗前NLR、PLR与Ⅲ期老年非小细胞肺癌病人预后的相关性

王天, 叶劲军, 李慧, 时书童, 张治, 周国仁, 王强, 张熔熔, 何侠

221004 江苏省徐州市,徐州医科大学(王天,何侠);
210009 江苏省南京市,江苏省肿瘤医院放疗科(叶劲军,李慧,时书童); 胸外科(张治); 内科(周国仁);
225500 江苏省泰州市,南京中医药大学姜堰附属医院肿瘤科(王强,张熔熔)

收稿日期:2022-11-29 出版日期:2023-11-20 发布日期:2023-11-22
通讯作者: 何侠,Email:hexiabm@163.com
基金资助:
江苏省六大人才高峰创新人才团队项目(TD-SWXY-007);吴阶平医学基金会项目(320.6750.19194-60)

Correlation of NLR and PLR before immune consolidation therapy with prognosis in elderly patients with stage Ⅲ non-small cell lung cancer

WANG Tian, YE Jin-jun, LI Hui, SHI Shu-tong, ZHANG Zhi, ZHOU Guo-ren, WANG Qiang, ZHANG Rong-rong, HE Xia

Xuzhou Medical University, Xuzhou 221004, China(WANG Tian, HE Xia);
Department of Radiation Oncology(YE Jin-jun, LI Hui, SHI Shu-tong); Department of Thoracic Surgery(ZHANG Zhi); Department of Internal Medicine(ZHOU Guo-ren), Affiliated Cancer Hospital of Nanjing Medical University,Nanjing 210009,China;
Department of Oncology, Jiangyan Affiliated Hospital of Nanjing University of Chinese Medicine, Taizhou 225500, China(WANG Qiang, ZHANG Rong-rong)

Received:2022-11-29 Online:2023-11-20 Published:2023-11-22
Contact: HE Xia, Email:hexiabm@163.com

摘要/Abstract

摘要： 目的探讨中性粒细胞计数与淋巴细胞比值(NLR)和血小板与淋巴细胞比值(PLR)与接受免疫巩固治疗的Ⅲ期老年非小细胞肺癌(NSCLC)病人预后之间的相关性。方法选择江苏省肿瘤医院放疗科2017年8月至2022年2月收治的根治性放化疗(CRT)后接受程序性死亡受体1(PD-1)抑制剂巩固治疗的Ⅲ期老年NSCLC病人83例为研究对象,收集病人的一般临床资料和血液学参数。利用X-tile软件计算83例病人NLR和PLR的最佳临界值。使用Kaplan-Meier法绘制生存曲线,采用log-rank检验比较亚组的总生存期(OS)和无进展生存期(PFS),通过单因素和多因素Cox回归分析评估基线特征和血液学参数与预后的相关性。结果 83例病人中位随访时间为16.3个月,中位PFS为15.2个月,中位OS为29.0个月。NLR和PLR预测PFS和OS的最佳临界值分别为3和196。亚组分析表明:低NLR和低PLR与良好的PFS(HR=0.33, 95%CI:0.18~0.61, P＜0.01;HR=0.32, 95%CI:0.18~0.58,P＜0.01)和OS(HR=0.35, 95%CI:0.15~0.85, P＜0.05;HR=0.22, 95%CI:0.09~0.54, P＜0.01)相关。进一步Cox回归分析显示,PLR影响PFS,ALC与OS相关。结论行根治性CRT后的Ⅲ期老年肺癌病人在随后的PD-1抑制剂治疗中有所获益。PD-1抑制剂治疗前低PLR、高ALC水平与老年病人较好的预后相关,其中PLR可能是PD-1抑制剂巩固治疗的预后预测指标。

关键词: 中性粒细胞计数与淋巴细胞比值, 血小板与淋巴细胞比值, 非小细胞肺癌, 老年人, 根治性放化疗, 程序性死亡受体1抑制剂

Abstract: Objective To investigate the correlation of neutrophil to lymphocyte ratio(NLR), platelet to lymphocyte ratio (PLR) with the prognosis in the elderly patients with stage Ⅲ non-small cell lung cancer (NSCLC) treated with radical chemo radiotherapy (CRT) followed by immune consolidation therapy. Methods A total of 83 elderly patients with stage Ⅲ NSCLC admitted to Radiotherapy Department of Jiangsu Cancer Hospital who received radical CRT followed by programmed cell death protein (PD-1) inhibitor consolidation therapy were enrolled. The baseline data and hematological parameters of all patients were collected. X-tile software was used to select the best threshold values of NLR and PLR in the 83 patients. Progression-free survival (PFS) and overall survival (OS) were assessed by Kaplan-Meier. And log-rank test was used to compare OS and PFS between subgroups. The correlation of the baseline characteristics and hematological parameters with prognosis were assessed by univariate and multivariate Cox regression analysis. Results In this study, the median follow-up time was 16.3 months, and the median PFS was 15.2 months, and the median OS was 29.0 months. The best cut-off values of NLR and PLR predicting PFS and OS were 3 and 196 respectively. Subgroup analysis showed that low NLR and low PLR were associated with good PFS (HR=0.33, 95%CI:0.18-0.61, P<0.01; HR=0.32, 95%CI:0.18-0.58, P<0.01) and OS (HR=0.35, 95%CI:0.15-0.85, P＜0.05; HR=0.22, 95%CI:0.09-0.54, P<0.01). Cox regression analysis showed PLR were associated with PFS, and ALC, were associated with OS. Conclusions Elderly patients with stage Ⅲ NSCLC who have undergone radical CRT are likely to benefit from subsequent immunotherapy. Low levels of NLR and PLR before PD-1 inhibitor therapy are associated with a better prognosis in the elderly patients, and PLR may be a prognostic indicator for PD-1 inhibitor consolidation therapy.

Key words: neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, non-small cell lung cancer, aged, radical chemoradiotherapy, programmed cell death protein1 inhibitor

中图分类号:

R 734.2

王天, 叶劲军, 李慧, 时书童, 张治, 周国仁, 王强, 张熔熔, 何侠. 免疫巩固治疗前NLR、PLR与Ⅲ期老年非小细胞肺癌病人预后的相关性[J]. 实用老年医学, 2023, 37(11): 1120-1124.

WANG Tian, YE Jin-jun, LI Hui, SHI Shu-tong, ZHANG Zhi, ZHOU Guo-ren, WANG Qiang, ZHANG Rong-rong, HE Xia. Correlation of NLR and PLR before immune consolidation therapy with prognosis in elderly patients with stage Ⅲ non-small cell lung cancer[J]. Practical Geriatrics, 2023, 37(11): 1120-1124.

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免疫巩固治疗前NLR、PLR与Ⅲ期老年非小细胞肺癌病人预后的相关性

Correlation of NLR and PLR before immune consolidation therapy with prognosis in elderly patients with stage Ⅲ non-small cell lung cancer

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