Department of Nuclear Medicine, Institut Curie, 92210 Saint-Cloud, France; Laboratoire d'Imagerie Translationnelle en Oncologie, Inserm, Institut Curie, 91401, Orsay, France.
Department of Pneumology, Paris-Est University, Centre Hospitalier Inter-Communal de Créteil, Inserm U955, UPEC, IMRB, équipe CEpiA, 94010 Créteil, France; Inserm, Centre de Recherche des Cordeliers, Sorbonne University, Université de Paris, Functionnal Genomics of Solid Tumors Laboratory, F-75006 Paris, France.
Lung Cancer. 2021 Sep;159:45-55. doi: 10.1016/j.lungcan.2021.06.024. Epub 2021 Jul 20.
We aimed to compare the prognostic value of inflammatory biomarkers extracted from pretreatment peripheral blood and [18F]-FDG PET for estimating outcomes in non-small cell lung cancer (NSCLC) patients treated with first-line immunotherapy (IT) or chemotherapy (CT).
In this retrospective multicenter study, we evaluated 111 patients with advanced NSCLC who underwent baseline [18F]-FDG PET/CT before IT or CT between 2016 and 2019. Several blood inflammatory indices were evaluated: derived neutrophil-to-lymphocyte ratio (dNLR), platelet-to-lymphocyte ratio (PLR), C-reactive protein (CRP) and systemic immune-inflammation index (SII). FDG-PET inflammatory parameters were extracted from lymphoid tissues (BLR and SLR: bone marrow or spleen-to-Liver SUVmax ratios). Association with survival and relationships between parameters were evaluated using Cox prediction models and Spearman's correlation respectively.
Overall, 90 patients were included (IT:CT) (51:39pts). Median PFS was 8.6:6.6 months and median OS was not reached:21.2 months. In the IT cohort, high dNLR (>3), high SII (≥1,270) and high SLR (0.77) were independent statistically significant prognostic factors for one-year progression-free survival (1y-PFS) and two-year overall survival (2y-OS) on multivariable analysis. In the CT cohort, high BLR (≥0.80) and high dNLR (>3) were associated with shorter 1y-PFS (HR 2.2, 95% CI 1.0-4.9) and 2y-OS (HR 3.4, 95CI 1.1-10.3) respectively, on multivariable analysis. Finally, BLR significantly but moderately correlated with most blood-based inflammatory indices (CRP, PLR and SII) while SLR was only associated with CRP (p < 0.01 for all).
In advanced NSCLC patients undergoing first-line IT or CT, pretreatment blood and inflammatory factors evaluating the spleen or bone marrow on [18F]-FDG PET/CT provided prognostic information for 1y-PFS and 2y-OS. These biomarkers should be further evaluated for potential clinical application.
我们旨在比较从预处理外周血和[18F]-FDG PET 提取的炎症生物标志物在预测接受一线免疫治疗（IT）或化疗（CT）的非小细胞肺癌（NSCLC）患者结局方面的价值。
在这项回顾性多中心研究中，我们评估了 2016 年至 2019 年间 111 例接受 IT 或 CT 治疗的晚期 NSCLC 患者基线[18F]-FDG PET/CT 前的情况。评估了几种血液炎症指标：衍生中性粒细胞与淋巴细胞比值（dNLR）、血小板与淋巴细胞比值（PLR）、C 反应蛋白（CRP）和全身免疫炎症指数（SII）。从淋巴组织（BLR 和 SLR：骨髓或脾脏与肝脏 SUVmax 的比值）中提取 FDG-PET 炎症参数。使用 Cox 预测模型评估与生存的关系，并使用 Spearman 相关分析评估参数之间的关系。
共有 90 例患者入组（IT：CT）（51：39 例）。中位 PFS 分别为 8.6：6.6 个月，中位 OS 未达到：21.2 个月。在 IT 队列中，高 dNLR（>3）、高 SII（≥1270）和高 SLR（0.77）是多变量分析中独立的一年无进展生存（1y-PFS）和两年总生存（2y-OS）的统计学显著预后因素。在 CT 队列中，高 BLR（≥0.80）和高 dNLR（>3）与较短的 1y-PFS（HR 2.2，95%CI 1.0-4.9）和 2y-OS（HR 3.4，95CI 1.1-10.3）相关，多变量分析。最后，BLR 与大多数基于血液的炎症指标（CRP、PLR 和 SII）显著但中度相关，而 SLR 仅与 CRP 相关（p<0.01）。
在接受一线 IT 或 CT 的晚期 NSCLC 患者中，预处理外周血和[18F]-FDG PET/CT 评估脾脏或骨髓的炎症因子提供了 1y-PFS 和 2y-OS 的预后信息。这些生物标志物应进一步评估其潜在的临床应用价值。
