Department of Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan.
Department of Perioperative Functioning Care and Support, Hamamatsu University School of Medicine, Shizuoka, Japan.
Anticancer Res. 2022 Jun;42(6):2977-2987. doi: 10.21873/anticanres.15781.
BACKGROUND/AIM: Although the effectiveness of immune checkpoint inhibitors (ICIs) in upper gastrointestinal (UGI) cancer including esophageal squamous cell carcinoma (ESCC) and gastric/gastroesophageal adenocarcinoma (GEA) has been proven, prediction of their efficacy remains unknown. This study aimed to develop optimal serum nutritional indicators or a combination of blood cell components to predict the efficacy of ICI before beginning UGI cancer treatment.
We retrospectively reviewed the data of 61 UGI cancers (31 ESCC and 30 GEA) patients treated with nivolumab or pembrolizumab. We investigated the impact of serum albumin level, total lymphocyte count (TLC), prognostic nutritional index (PNI), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) on the efficacy of ICIs and long-term survival. The median cutoff value was adopted separately in ESCC and GEA.
NLR-Low was significantly correlated with better overall survival (p=0.014), and PLR-Low was significantly correlated with improved disease control rate and better progression-free survival in UGI cancer patients. Both results indicate that a better prognosis is correlated to a greater number of lymphocytes. Multivariate analysis revealed that NLR-High [hazard ratio (HR)=2.865; 95% confidence interval (CI)=1.030-7.937; p=0.044] was the only independent poor prognostic factor.
NLR-Low has the potential to predict the good efficacy of ICIs and survival outcomes in patients with UGI cancer. NLR could be useful in determining the optimal treatment strategies for these patients.
背景/目的：免疫检查点抑制剂（ICIs）在上消化道（UGI）癌症包括食管鳞状细胞癌（ESCC）和胃/胃食管腺癌（GEA）中的有效性已得到证实，但它们疗效的预测仍然未知。本研究旨在开发最佳的血清营养指标或血细胞成分组合，以预测开始 UGI 癌症治疗前 ICI 的疗效。
我们回顾性分析了 61 例接受纳武利尤单抗或帕博利珠单抗治疗的 UGI 癌症（31 例 ESCC 和 30 例 GEA）患者的数据。我们研究了血清白蛋白水平、总淋巴细胞计数（TLC）、预后营养指数（PNI）、中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）和淋巴细胞与单核细胞比值（LMR）对 ICI 疗效和长期生存的影响。中位数临界值分别在 ESCC 和 GEA 中采用。
NLR-Low 与总生存期显著相关（p=0.014），PLR-Low 与 UGI 癌症患者的疾病控制率提高和无进展生存期改善显著相关。这两个结果都表明，更多的淋巴细胞与更好的预后相关。多变量分析显示，NLR-High [风险比（HR）=2.865；95%置信区间（CI）=1.030-7.937；p=0.044] 是唯一的独立不良预后因素。
NLR-Low 有可能预测 UGI 癌症患者 ICI 的良好疗效和生存结局。NLR 可用于确定这些患者的最佳治疗策略。
