外周血标志物和 C 反应蛋白对纳武利尤单抗治疗转移性肾细胞癌的预测影响。
Predictive Impact of Peripheral Blood Markers and C-Reactive Protein in Nivolumab Therapy for Metastatic Renal Cell Carcinoma.
机构信息
Department of Urology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
Department of Urology, Tokyo Women's Medical University Medical Center East, 2-1-10 Nishiogu, Arakawa-ku, Tokyo, 116-8567, Japan.
出版信息
Target Oncol. 2019 Aug;14(4):453-463. doi: 10.1007/s11523-019-00660-6.
BACKGROUND
Predictive factors that can be routinely used in clinical practice are critically needed for immune checkpoint inhibitor therapy in metastatic renal cell carcinoma (mRCC).
OBJECTIVE
To comprehensively analyze the predictive impact of peripheral blood markers and C-reactive protein (CRP) in nivolumab therapy for mRCC.
METHODS
Fifty-eight patients were retrospectively evaluated. We evaluated neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), absolute eosinophil count (AEC), and absolute monocyte count (AMC) as peripheral blood markers as well as serum CRP levels. The primary endpoints were progression-free survival (PFS) and overall survival (OS) after nivolumab initiation.
RESULTS
Median PFS was significantly shorter in patients with high NLR (≥ 3) versus low NLR (p = 0.0356), high MLR (≥ 0.3) versus low MLR (p = 0.0013), or high PLR (≥ 160) versus low PLR (p = 0.0073), and median OS was significantly shorter in patients with high NLR versus low NLR (p = 0.0025), high MLR versus low MLR (p = 0.0025), high PLR versus low PLR (p = 0.0256), or high CRP (≥ 1.0 mg/dl) versus low CRP (p = 0.0006). Multivariate analyses showed that MLR (HR 2.65, p = 0.0068) was an independent factor for PFS and that NLR (HR 3.34, p = 0.0218), MLR (HR 3.42, p = 0.0381), and CRP (HR 4.98, p = 0.0108) were independent factors for OS.
CONCLUSIONS
The systemic inflammatory factors NLR, MLR, and CRP were predictive factors in nivolumab therapy for mRCC. These easily monitored factors can contribute to effective treatment and follow-up.
背景
对于转移性肾细胞癌（mRCC）的免疫检查点抑制剂治疗，迫切需要能够在临床实践中常规使用的预测因素。
目的
全面分析外周血标志物和 C 反应蛋白（CRP）对 nivolumab 治疗 mRCC 的预测影响。
方法
回顾性评估了 58 例患者。我们评估了中性粒细胞与淋巴细胞比值（NLR）、单核细胞与淋巴细胞比值（MLR）、血小板与淋巴细胞比值（PLR）、绝对嗜酸性粒细胞计数（AEC）和绝对单核细胞计数（AMC）作为外周血标志物以及血清 CRP 水平。主要终点是 nivolumab 起始后无进展生存期（PFS）和总生存期（OS）。
结果
NLR（≥3）较高的患者中位 PFS 明显短于 NLR（<3）较低的患者（p=0.0356），MLR（≥0.3）较高的患者中位 OS 明显短于 MLR（<0.3）较低的患者（p=0.0013），PLR（≥160）较高的患者中位 OS 明显短于 PLR（<160）较低的患者（p=0.0073），NLR 较高的患者中位 OS 明显短于 NLR（<3）较低的患者（p=0.0025），MLR 较高的患者中位 OS 明显短于 MLR（<0.3）较低的患者（p=0.0025），PLR 较高的患者中位 OS 明显短于 PLR（<160）较低的患者（p=0.0256），或 CRP（≥1.0mg/dl）较高的患者中位 OS 明显短于 CRP（<1.0mg/dl）较低的患者（p=0.0006）。多变量分析显示，MLR（HR 2.65，p=0.0068）是 PFS 的独立因素，而 NLR（HR 3.34，p=0.0218）、MLR（HR 3.42，p=0.0381）和 CRP（HR 4.98，p=0.0108）是 OS 的独立因素。
结论
全身炎症因子 NLR、MLR 和 CRP 是 nivolumab 治疗 mRCC 的预测因素。这些易于监测的因素有助于进行有效的治疗和随访。
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