治疗前中性粒细胞与淋巴细胞比值作为不可切除或转移性食管癌患者接受抗PD-1治疗时的预后生物标志物

Pretreatment Neutrophil-to-Lymphocyte Ratio as a Prognostic Biomarker in Unresectable or Metastatic Esophageal Cancer Patients With Anti-PD-1 Therapy.

作者信息

Gao Yiming, Zhang Zhibo, Li Yao, Chen Siyuan, Lu Jiangyue, Wu Liangliang, Ma Zhiqiang, Hu Yi, Zhang Guoqing

机构信息

Medical School of Chinese People's Liberation Army (PLA), Beijing, China.

Department of Oncology, The First Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China.

出版信息

Front Oncol. 2022 Apr 13;12:834564. doi: 10.3389/fonc.2022.834564. eCollection 2022.

BACKGROUND

The neutrophil-to-lymphocyte ratio (NLR) is an inflammatory index calculated by the absolute neutrophil count dividing the absolute lymphocyte count, and its prognostic role in esophageal cancer (EC) patients with anti-PD-1 therapy remains unclear.

METHODS

A total of 140 unresectable or metastatic EC patients receiving PD-1 inhibitor treatment were included from Jan 2016 to Mar 2020. Kaplan-Meier method and log-rank test were used for comparing overall survival (OS) and progression-free survival (PFS) between groups. Multivariate Cox analysis was performed to assess the prognostic value of NLR.

RESULTS

The cutoff value of NLR was set at 5, and the median follow-up time was 20.0 months. Patients with pretreatment NLR <5 had higher ORR (46.7% vs. 12.1%; < 0.001) and DCR (85.0% vs. 69.7%; = 0.047) than those with NLR ≥5. Kaplan-Meier curves showed that pretreatment NLR <5 was associated with longer PFS (median: 10.0 vs. 3.5 months, < 0.0001) and OS (median: 22.3 vs. 4.9 months, < 0.0001). Multivariate analysis demonstrated that pretreatment NLR ≥5 independently and significantly increased the risk of disease progression (hazard ratio (HR), 1.77 (95% confidence interval (CI), 1.12-2.82); = 0.015) and death (HR, 4.01 (95% CI, 2.28-7.06); < 0.001). Subgroup analysis showed that pretreatment NLR ≥5 was associated with poor efficacy and survival in most subsets.

CONCLUSIONS

Our findings showed that pretreatment NLR was independently and significantly associated with the efficacy and prognosis of EC patients treated with PD-1 inhibitors. NLR could serve as a convenient and useful prognostic biomarker for EC patients with anti-PD-1 therapy.

背景

中性粒细胞与淋巴细胞比值（NLR）是一种通过绝对中性粒细胞计数除以绝对淋巴细胞计数计算得出的炎症指标，其在接受抗PD - 1治疗的食管癌（EC）患者中的预后作用尚不清楚。

方法

纳入2016年1月至2020年3月期间共140例接受PD - 1抑制剂治疗的不可切除或转移性EC患者。采用Kaplan - Meier法和对数秩检验比较各组间的总生存期（OS）和无进展生存期（PFS）。进行多因素Cox分析以评估NLR的预后价值。

结果

NLR的临界值设定为5，中位随访时间为20.0个月。治疗前NLR <5的患者比NLR≥5的患者具有更高的客观缓解率（ORR）（46.7%对12.1%；<0.001）和疾病控制率（DCR）（85.0%对69.7%；=0.047）。Kaplan - Meier曲线显示，治疗前NLR <5与更长的PFS（中位值：10.0对3.5个月，<0.0001）和OS（中位值：22.3对4.9个月，<0.0001）相关。多因素分析表明，治疗前NLR≥5独立且显著增加疾病进展风险（风险比（HR），1.77（95%置信区间（CI），1.12 - 2.82）；=0.015）和死亡风险（HR，4.01（95% CI，2.28 - 7.06）；<0.001）。亚组分析显示，治疗前NLR≥5在大多数亚组中与疗效不佳和生存期短相关。