Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173 beon-gil, Bundang-Gu, Seongnam, Gyeonggi-do, 13620, Republic of Korea.
Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
Cancer Immunol Immunother. 2018 Mar;67(3):459-470. doi: 10.1007/s00262-017-2092-x. Epub 2017 Dec 4.
We investigated inflammatory markers such as the neutrophil-to-lymphocyte ratio (NLR) that may predict the response to anti-PD-1 (programmed cell death protein 1) antibody therapy. Data from 54 patients with non-small cell lung cancer (NSCLC) treated with anti-PD-1 antibodies were retrospectively analyzed. The NLR was assessed at baseline and 6 weeks after the start of treatment (post-treatment). Eighteen of 54 patients (33.3%) had objective responses to treatment. Older age, absence of brain metastasis, low post-treatment NLR (< 5), and immune-related adverse events were significantly associated with response. Patients with a high post-treatment NLR (≥ 5) had significantly shorter progression-free survival (PFS) than those with a low post-treatment NLR (median, 1.3 vs. 6.1 months, p < 0.001). Multivariate analysis demonstrated that high post-treatment NLR [hazard ratio (HR) 15.1, 95% confidence interval (CI) 1.5-50.1, p < 0.001], liver metastasis (HR 4.9, 95% CI 1.9-12.4, p = 0.001), and brain metastasis (HR 3.2, 95% CI 1.3-8.2, p = 0.013) were independent prognostic factors of shorter PFS. Overall survival (OS) was significantly different in patients with high and low post-treatment NLRs (median, 2.1 vs. 14.0 months, p < 0.001). A high post-treatment NLR remained an independent prognostic factor for OS in multivariate analysis (HR 3.9, 95% CI 1.6-9.2, p = 0.003). The NLR at 6 weeks after treatment initiation was a prognostic marker in patients with advanced NSCLC treated with anti-PD-1 antibody. Further studies are warranted to evaluate the role of the 6-week NLR as a predictor in anti-PD-1 antibody treatment.
我们研究了一些炎症标志物，如中性粒细胞与淋巴细胞比值（NLR），这些标志物可能预测抗 PD-1（程序性细胞死亡蛋白 1）抗体治疗的反应。对 54 例接受抗 PD-1 抗体治疗的非小细胞肺癌（NSCLC）患者的数据进行了回顾性分析。NLR 在基线和治疗开始后 6 周（治疗后）进行评估。54 例患者中，18 例（33.3%）对治疗有客观反应。较年长的年龄、无脑转移、治疗后 NLR 较低（<5）和免疫相关不良事件与反应显著相关。治疗后 NLR 较高（≥5）的患者无进展生存期（PFS）明显短于治疗后 NLR 较低的患者（中位数，1.3 个月与 6.1 个月，p<0.001）。多变量分析表明，治疗后 NLR 较高（HR 15.1，95%CI 1.5-50.1，p<0.001）、肝转移（HR 4.9，95%CI 1.9-12.4，p=0.001）和脑转移（HR 3.2，95%CI 1.3-8.2，p=0.013）是 PFS 较短的独立预后因素。治疗后 NLR 较高和较低的患者的总生存期（OS）有显著差异（中位数，2.1 个月与 14.0 个月，p<0.001）。多变量分析显示，治疗后 NLR 较高是 OS 的独立预后因素（HR 3.9，95%CI 1.6-9.2，p=0.003）。治疗开始后 6 周的 NLR 是接受抗 PD-1 抗体治疗的晚期 NSCLC 患者的预后标志物。需要进一步研究以评估 6 周 NLR 作为抗 PD-1 抗体治疗预测因子的作用。
