Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy.
Department of Obstetrics and Gynaecology, San Raffaele Scientific Institute, Milan, Italy.
Target Oncol. 2018 Aug;13(4):469-479. doi: 10.1007/s11523-018-0574-1.
The variability in progression-free survival (PFS) and overall survival (OS) among patients with epithelial ovarian cancer (EOC) makes it difficult to reliably predict outcomes. A predictive biomarker of bevacizumab efficacy as first-line therapy in EOC is still lacking.
The MITO group conducted a multicenter, retrospective study (MITO 24) to investigate the role of inflammatory indexes as prognostic factors and predictors of treatment efficacy in FIGO stage III-IV EOC patients treated with first-line chemotherapy alone or in combination with bevacizumab.
Of the 375 patients recruited, 301 received chemotherapy alone and 74 received chemotherapy with bevacizumab. The pre-treatment neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune inflammation index (SII) were evaluated to identify a potential correlation with PFS and OS in both the overall population and the two treatment arms.
In the overall population, the PFS and OS were significantly longer in patients with low inflammatory indexes (p < 0.0001). In multivariate analyses, the NLR was significantly associated with OS (p = 0.016), and the PLR was significantly associated with PFS (p = 0.024). Inflammatory indexes were significantly correlated with patient prognosis in the chemotherapy-alone group (p < 0.0001). Patients in the chemotherapy with bevacizumab group with a high NLR had a higher PFS and OS (p = 0.026 and p = 0.029, respectively) than those in the chemotherapy-alone group. Conversely, PFS and OS were significantly poorer in patients with a high SII (p = 0.024 and p = 0.017, respectively).
Our results suggest that bevacizumab improves clinical outcome in patients with a high NLR but may be detrimental in those with a high SII.
上皮性卵巢癌（EOC）患者的无进展生存期（PFS）和总生存期（OS）存在差异，使得可靠预测结局变得困难。目前仍缺乏贝伐珠单抗作为 EOC 一线治疗的疗效预测生物标志物。
MITO 小组进行了一项多中心、回顾性研究（MITO 24），旨在研究炎症指标作为预后因素和预测因子的作用，以评估其在接受单纯一线化疗或联合贝伐珠单抗治疗的FIGO 分期 III-IV 期 EOC 患者中的疗效。
在纳入的 375 例患者中，301 例接受单纯化疗，74 例接受化疗联合贝伐珠单抗。评估治疗前中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）和全身免疫炎症指数（SII），以确定其与全人群及两种治疗组的 PFS 和 OS 的潜在相关性。
在全人群中，低炎症指数患者的 PFS 和 OS 显著延长（p<0.0001）。多因素分析显示，NLR 与 OS 显著相关（p=0.016），PLR 与 PFS 显著相关（p=0.024）。在单纯化疗组中，炎症指标与患者预后显著相关（p<0.0001）。贝伐珠单抗联合化疗组中 NLR 较高的患者 PFS 和 OS 较高（p=0.026 和 p=0.029），而单纯化疗组则较低。相反，SII 较高的患者 PFS 和 OS 显著较差（p=0.024 和 p=0.017）。
我们的研究结果表明，贝伐珠单抗可改善 NLR 较高患者的临床结局，但可能对 SII 较高患者有害。
