Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
Int J Clin Oncol. 2020 Jan;25(1):74-81. doi: 10.1007/s10147-019-01539-2. Epub 2019 Sep 17.
Anti-programmed cell death receptor (PD)-1 antibody treatment results in better prognosis than standard chemotherapy in patients with non-small cell lung cancer (NSCLC), especially those with high PD-ligand 1 (PD-L1) expression. However, several studies have reported a lack of antitumor effect of PD-1 antibody, even in patients with high PD-L1 expression. Therefore, reliable predictors of treatment response are urgently needed. The albumin-globulin ratio (AGR) is associated with prognosis in several cancers. We aimed to determine whether AGR is a predictive biomarker of anti-PD-1 antibody response in patients with NSCLC.
Seventy-four NSCLC patients treated with anti-PD-1 antibody were retrospectively enrolled. Patients with driver mutations were excluded.
The mean AGR was significantly higher in the disease control (DC) group than in the progressive disease (PD) group (p < 0.001). Receiver operating characteristic curve analysis revealed an AGR cutoff value for dividing patients into the DC or PD groups of 1.17. Multivariate logistic regression analysis showed that a high AGR (≥1.17, cutoff value) was an independent predictor of DC (p = 0.001). Progression-free survival (PFS) and overall survival (OS) were significantly longer in the high-AGR group than in the low-AGR group (p = 0.008, p = 0.002, respectively). Multivariate Cox regression analysis of PFS and OS showed that high AGR was an independent prognostic factor (p = 0.020, p < 0.001, respectively).
Pretreatment serum AGR may be a useful predictor for DC and prognostic factor of anti-PD-1 antibody in patients with NSCLC. The clinical utility of AGR still needs to be confirmed in a prospective analysis.
与标准化疗相比，抗程序性细胞死亡受体（PD）-1 抗体治疗可改善非小细胞肺癌（NSCLC）患者的预后，尤其是那些 PD-配体 1（PD-L1）高表达的患者。然而，一些研究报告称，即使在 PD-L1 高表达的患者中，PD-1 抗体也缺乏抗肿瘤作用。因此，迫切需要可靠的治疗反应预测指标。白蛋白-球蛋白比值（AGR）与多种癌症的预后相关。我们旨在确定 AGR 是否是 NSCLC 患者抗 PD-1 抗体反应的预测生物标志物。
回顾性纳入 74 例接受抗 PD-1 抗体治疗的 NSCLC 患者。排除有驱动基因突变的患者。
疾病控制（DC）组的平均 AGR 明显高于进展性疾病（PD）组（p<0.001）。ROC 曲线分析显示，将患者分为 DC 或 PD 组的 AGR 截断值为 1.17。多因素逻辑回归分析显示，高 AGR（≥1.17，截断值）是 DC 的独立预测因素（p=0.001）。高 AGR 组的无进展生存期（PFS）和总生存期（OS）明显长于低 AGR 组（p=0.008，p=0.002）。PFS 和 OS 的多因素 Cox 回归分析显示，高 AGR 是独立的预后因素（p=0.020，p<0.001）。
治疗前血清 AGR 可能是 NSCLC 患者 DC 和抗 PD-1 抗体预后的有用预测指标。AGR 的临床实用性仍需在前瞻性分析中得到证实。
