Takamori Shinkichi, Takada Kazuki, Shimokawa Mototsugu, Matsubara Taichi, Fujishita Takatoshi, Ito Kensaku, Toyozawa Ryo, Yamaguchi Masafumi, Okamoto Tatsuro, Yoneshima Yasuto, Tanaka Kentaro, Okamoto Isamu, Tagawa Tetsuzo, Mori Masaki
Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan.
Department of Thoracic Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku, Kokurakita-ku, Kitakyushu, Fukuoka, Japan.
Lung Cancer. 2021 Feb;152:27-33. doi: 10.1016/j.lungcan.2020.11.026. Epub 2020 Dec 4.
Immune checkpoint inhibitors (ICIs) have become one of the standard therapies in non-small-cell lung cancer (NSCLC). Although inflammatory indices, including Glasgow prognostic score (GPS), modified Glasgow prognostic score (mGPS), and C-reactive protein/albumin ratio (CAR) were reported to be reliable predictors for survival in cancer patients, their clinical utility in NSCLC patients treated with ICIs is unknown.
Advanced or recurrent NSCLC patients (n = 304) treated with ICI monotherapy at the National Hospital Organization Kyushu Cancer Center and Kyushu University Hospital between January 2016 and December 2019 were analyzed. Information on patient demographics, GPS, mGPS, and CAR at diagnosis were collected. The time-dependent area under curves (AUCs) of receiver operating characteristic curves for the prediction of overall survival (OS) for each factor were compared.
Of the three indices, GPS was the most significantly correlated with the degree of disease control rate (DCR) (DCR of GPS of 0, 1, and 2: 63.6 %, 49.4 %, and 41.4 %, respectively). The time-dependent AUC values of GPS for the prediction of OS were superior to those of mGPS and CAR (time-dependent AUC values of GPS, mGPS, and CAR for the prediction of 1-year OS: 0.7005, 0.6736, and 0.6565, respectively). GPS was significantly correlated with performance status (PS) (P < 0.0001) and clinical stage (P = 0.0139). GPS in combination with PS effectively predicted survival at 1 year ranging from 83.5 % (GPS = 0, PS = 0) to 25.0 % (GPS = 2, PS = 2, 3). A multivariable analysis revealed that GPS was an independent predictor of PFS and OS (P = 0.0009 and P = 0.0100, respectively).
We report for the first time that GPS represents a simple and useful prognostic factor in NSCLC patients treated with ICIs and should be validated prospectively.
免疫检查点抑制剂（ICIs）已成为非小细胞肺癌（NSCLC）的标准治疗方法之一。尽管包括格拉斯哥预后评分（GPS）、改良格拉斯哥预后评分（mGPS）和C反应蛋白/白蛋白比值（CAR）在内的炎症指标被报道为癌症患者生存的可靠预测指标，但其在接受ICIs治疗的NSCLC患者中的临床应用尚不清楚。
分析了2016年1月至2019年12月期间在国立医院组织九州癌症中心和九州大学医院接受ICI单药治疗的晚期或复发性NSCLC患者（n = 304）。收集了患者人口统计学信息、诊断时的GPS、mGPS和CAR。比较了各因素预测总生存期（OS）的受试者操作特征曲线的时间依赖性曲线下面积（AUCs）。
在这三个指标中，GPS与疾病控制率（DCR）的相关性最为显著（GPS为0、1和2时的DCR分别为63.6%、49.4%和41.4%）。GPS预测OS的时间依赖性AUC值优于mGPS和CAR（GPS、mGPS和CAR预测1年OS的时间依赖性AUC值分别为0.7005、0.6736和0.6565）。GPS与体能状态（PS）（P < 0.0001）和临床分期（P = 0.0139）显著相关。GPS与PS联合使用能有效预测1年生存率，范围从83.5%（GPS = 0，PS = 0）到25.0%（GPS = 2，PS = 2、3）。多变量分析显示，GPS是无进展生存期（PFS）和OS的独立预测指标（分别为P = 0.0009和P = 0.0100）。
我们首次报道，GPS是接受ICIs治疗的NSCLC患者一个简单且有用的预后因素，应进行前瞻性验证。
