Huang Jing, Pu Hongjiang, He Jintao, Tang Xiaohu
The First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, People's Republic of China.
Department of Integrated Traditional Chinese and Western Medicine, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Centre, Kunming, People's Republic of China.
Int J Gen Med. 2023 Mar 7;16:881-893. doi: 10.2147/IJGM.S393263. eCollection 2023.
Most cancer-related deaths around the globe are caused by lung cancer. The present treatments for metastatic non-small cell lung cancer (mNSCLC) are cytotoxic chemotherapy (CCT), targeted therapy (TT) and immunotherapy, but the benefit of the same regime varies greatly. Hence, it is important to identify biomarkers to predict the efficacy of modalities. Previous literature suggested certain parameters might be predictive factors. Nevertheless, the utility of these parameters is limited due to the types of solid tumors.
The study aimed to examine whether the lung immune prognostic index (LIPI) was related to outcomes of CCT, immune checkpoint inhibitors (ICIs) and TT for mNSCLC patients.
A retrospective cohort study between September 2012 and May 2020 was conducted on 350 Chinese mNSCLC patients, including 147 patients receiving ICIs, 103 TT, and 100 CCT. The data were examined to analyze the prognostic value of LIPI among various treatments.
The associations between PFS and good, intermediate, or poor prognostic LIPI scores in ICIs, TT, and CCT were determined, respectively.
In univariable analyses, there was a relevance between a good LIPI score and better PFS among patients receiving ICIs (HR, 0.81; 95% CI, 0.44-1.51), TT (HR, 0.35; 95% CI, 0.16-1.74), and CCT (HR, 0.39; 95% CI, 0.19-0.80). In multivariable analyses, the intermediate LIPI score was linked to better PFS only in patients receiving TT (HR, 0.31; 95% CI, 0.17-0.92) rather than ICIs (HR, 1.12; 95% CI, 0.66-2.45) or CCT (HR, 1.24; 95% CI, 0.49-4.55).
Baseline LIPI value is an important prognostic biomarker for mNSCLC patients treated with TT. Shorter PFS with TT was associated with poor baseline LIPI. Poor LIPI score may be considered as a promising indicator showing which patients are unlikely to respond well to TT. The prognostic value of LIPI can be more clearly determined through prospective clinical study.
全球大多数癌症相关死亡由肺癌导致。目前转移性非小细胞肺癌（mNSCLC）的治疗方法有细胞毒性化疗（CCT）、靶向治疗（TT）和免疫治疗，但相同治疗方案的获益差异很大。因此，识别预测治疗方式疗效的生物标志物很重要。既往文献提示某些参数可能是预测因素。然而，由于实体瘤类型的原因，这些参数的实用性有限。
本研究旨在探讨肺免疫预后指数（LIPI）是否与mNSCLC患者的CCT、免疫检查点抑制剂（ICI）和TT治疗结果相关。
对2012年9月至2020年5月期间的350例中国mNSCLC患者进行了一项回顾性队列研究，其中147例患者接受ICI治疗，103例接受TT治疗，100例接受CCT治疗。对数据进行分析，以评估LIPI在不同治疗中的预后价值。
分别确定接受ICI、TT和CCT治疗的患者中，无进展生存期（PFS）与预后良好、中等或较差的LIPI评分之间的关联。
在单变量分析中，接受ICI治疗的患者（风险比[HR]，0.81；95%置信区间[CI]，0.44 - 1.51）、TT治疗的患者（HR，0.35；95% CI，0.16 - 1.74）和CCT治疗的患者（HR，0.39；95% CI，0.19 - 0.80）中，LIPI评分良好与较好的PFS相关。在多变量分析中，仅接受TT治疗的患者中，中等LIPI评分与较好的PFS相关（HR，0.31；95% CI，0.17 - 0.92），而接受ICI治疗的患者（HR，1.12；95% CI，0.66 - 2.45）或CCT治疗的患者（HR，1.24；95% CI，0.49 - 4.55）并非如此。
基线LIPI值是接受TT治疗的mNSCLC患者的重要预后生物标志物。TT治疗的PFS较短与基线LIPI较差相关。LIPI评分较差可被视为一个有前景的指标，表明哪些患者可能对TT治疗反应不佳。LIPI的预后价值可通过前瞻性临床研究更明确地确定。
