Department of Pulmonary and Critical Care Medicine, Peking University Shenzhen Hospital, Shenzhen, 518034, Guangdong, China.
Shantou University Medical College, Shantou, 515041, Guangdong, People's Republic of China.
Respir Res. 2023 Feb 27;24(1):64. doi: 10.1186/s12931-023-02370-0.
BACKGROUND: Immune checkpoint inhibitors (ICIs) are regarded as the most promising treatment for advanced-stage non-small cell lung cancer (aNSCLC). Unfortunately, there has been no unified accuracy biomarkers and systematic model specifically identified for prognostic and severe immune-related adverse events (irAEs). Our goal was to discover new biomarkers and develop a publicly accessible method of identifying patients who may maximize benefit from ICIs. METHODS: This retrospective study enrolled 138 aNSCLC patients receiving ICIs treatment. Progression-free survival (PFS) and severe irAEs were end-points. Data of demographic features, severe irAEs, and peripheral blood inflammatory-nutritional and immune indices before and after 1 or 2 cycles of ICIs were collected. Independent factors were selected by least absolute shrinkage and selection operator (LASSO) combined with multivariate analysis, and incorporated into nomogram construction. Internal validation was performed by applying area under curve (AUC), calibration plots, and decision curve. RESULTS: Three nomograms with great predictive accuracy and discriminatory power were constructed in this study. Among them, two nomograms based on combined inflammatory-nutritional biomarkers were constructed for PFS (1 year-PFS and 2 year-PFS) and severe irAEs respectively, and one nomogram was constructed for 1 year-PFS based on immune indices. ESCLL nomogram (based on ECOG PS, preSII, changeCAR, changeLYM and postLDH) was constructed to assess PFS (1-, 2-year-AUC = 0.893 [95% CI 0.837-0.950], 0.828 [95% CI 0.721-0.935]). AdNLA nomogram (based on age, change-dNLR, changeLMR and postALI) was constructed to predict the risk of severe irAEs (AUC = 0.762 [95% CI 0.670-0.854]). NKT-B nomogram (based on change-CD3+CD56+CD16+NKT-like cells and change-B cells) was constructed to assess PFS (1-year-AUC = 0.872 [95% CI 0.764-0.965]). Although immune indices could not be modeled for severe irAEs prediction due to limited data, we were the first to find CD3+CD56+CD16+NKT-like cells were not only correlated with PFS but also associated with severe irAEs, which have not been reported in the study of aNSCLC-ICIs. Furthermore, our study also discovered higher change-CD4+/CD8+ ratio was significantly associated with severe irAEs. CONCLUSIONS: These three new nomograms proceeded from non-invasive and straightforward peripheral blood data may be useful for decisions-making. CD3+CD56+CD16+NKT-like cells were first discovered to be an important biomarker for treatment and severe irAEs, and play a vital role in distinguishing the therapy response and serious toxicity of ICIs.
背景:免疫检查点抑制剂(ICIs)被认为是治疗晚期非小细胞肺癌(aNSCLC)最有前途的方法。不幸的是,目前还没有针对预后和严重免疫相关不良事件(irAEs)的统一准确性生物标志物和系统模型。我们的目标是发现新的生物标志物,并开发一种可公开访问的方法来识别可能从 ICI 中最大获益的患者。
方法:本回顾性研究纳入了 138 名接受 ICI 治疗的 aNSCLC 患者。无进展生存期(PFS)和严重 irAEs 为终点。收集患者人口统计学特征、严重 irAEs 以及免疫检查点抑制剂治疗前 1 或 2 个周期后外周血炎症-营养和免疫指标的数据。采用最小绝对收缩和选择算子(LASSO)联合多变量分析选择独立因素,并纳入列线图构建。采用曲线下面积(AUC)、校准图和决策曲线对内进行内部验证。
结果:本研究构建了三个具有较高预测准确性和区分能力的列线图。其中,两个基于联合炎症-营养生物标志物的列线图分别用于预测 PFS(1 年-PFS 和 2 年-PFS)和严重 irAEs,一个基于免疫指数的列线图用于预测 1 年-PFS。ESCLL 列线图(基于 ECOG PS、preSII、changeCAR、changeLYM 和 postLDH)用于评估 PFS(1 年-AUC=0.893[95%CI 0.837-0.950],0.828[95%CI 0.721-0.935])。AdNLA 列线图(基于年龄、change-dNLR、changeLMR 和 postALI)用于预测严重 irAEs 风险(AUC=0.762[95%CI 0.670-0.854])。NKT-B 列线图(基于 change-CD3+CD56+CD16+NKT-like cells 和 change-B cells)用于评估 PFS(1 年-AUC=0.872[95%CI 0.764-0.965])。尽管由于数据有限,无法对免疫指数进行严重 irAEs 预测建模,但我们是第一个发现 CD3+CD56+CD16+NKT-like cells 不仅与 PFS 相关,而且与严重 irAEs 相关的研究人员,这在 aNSCLC-ICIs 的研究中尚未报道。此外,我们的研究还发现,较高的 change-CD4+/CD8+比值与严重 irAEs 显著相关。
结论:这些从非侵入性和简单的外周血数据出发的三个新列线图可能有助于决策。CD3+CD56+CD16+NKT-like cells 是首次被发现的治疗和严重 irAEs 的重要生物标志物,在区分 ICI 治疗反应和严重毒性方面发挥着重要作用。
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