Wu Mengjing, Zhu Yunyun, Chen Xiancheng, Wang Xinpeng, Lin Xinyue, Yan Xue, Mo Peng, Ye Ying, Zeng Yanjing, Yang Yanyong, Fu Zhichao
Department of Radiotherapy, The 900th Hospital of the Joint Logistics Team, Fujian Medical University, Fuzhou, China.
Department of Radiotherapy, Dongfang Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.
J Gastrointest Oncol. 2023 Feb 28;14(1):54-63. doi: 10.21037/jgo-23-48. Epub 2023 Feb 24.
Immune checkpoint inhibitors (ICIs) play an important role in the treatment of esophageal cancer (EC). However, their efficacy is variable, and there are still no effective and convenient biomarkers to identify and assess their efficacy. In recent years, programmed cell death-ligand 1 (PD-L1) expression, tumor mutation burden (TMB) and other commonly used biomarkers still cannot meet clinical needs. PNI is easy to obtain and its predictive value for the prognosis of immunotherapy has been confirmed in many cancer species, but the relationship between PNI and the efficacy of immunotherapy for esophageal cancer is still unclear. Therefore, this study aims to explore the predictive value of PNI in advanced esophageal cancer treated with ICIs.
The clinicopathological features of 78 patients with advanced EC who received immunotherapy in the 900th Hospital of the Joint Logistics Team from September 2018 to May 2022 were retrospectively analyzed. The laboratory test results within 10 days prior to the start of ICI treatment were recorded, including absolute lymphocyte count and albumin (ALB) level. Meanwhile, the effects of pre-treatment prognostic nutritional index (PNI) and body mass index (BMI) on the overall survival (OS) and progression-free survival (PFS) in patients with advanced EC were analyzed.
The median age of the enrolled patients was 58 years, and 38 patients (48.7%) received second-or-later-line therapy. The median progression-free survival (mPFS) and median overall survival (mOS) were 7.4 months and 13 months, respectively. The mPFS and mOS were 8.8 months and 15 months, respectively, in the high baseline PNI subgroup, which were significantly higher than those in the low baseline PNI subgroup (4.7 and 8.2 months, respectively; both P<0.05). Multivariate regression analysis showed that low baseline PNI was an independent predictor of poor PFS [hazard studio (HR) =0.35, 95% CI: 0.14-0.85, P=0.020) and poor OS (HR =0.41, 95% CI: 0.17-0.99, P=0.047) and treatment line was an independent predictor of PFS. Baseline BMI was not significantly associated with prognosis.
PNI is a simple and effective biomarker for predicting the prognosis of immunotherapy in patients with advanced EC, although further prospective studies are warranted.
免疫检查点抑制剂（ICIs）在食管癌（EC）治疗中发挥着重要作用。然而，其疗效存在差异，目前仍缺乏有效且便捷的生物标志物来识别和评估其疗效。近年来，程序性细胞死亡配体1（PD-L1）表达、肿瘤突变负荷（TMB）等常用生物标志物仍无法满足临床需求。PNI易于获取，其对免疫治疗预后的预测价值已在多种癌症中得到证实，但PNI与食管癌免疫治疗疗效之间的关系仍不明确。因此，本研究旨在探讨PNI在接受ICIs治疗的晚期食管癌中的预测价值。
回顾性分析2018年9月至2022年5月在联勤保障部队第九〇〇医院接受免疫治疗的78例晚期EC患者的临床病理特征。记录ICI治疗开始前10天内的实验室检查结果，包括绝对淋巴细胞计数和白蛋白（ALB）水平。同时，分析治疗前预后营养指数（PNI）和体重指数（BMI）对晚期EC患者总生存期（OS）和无进展生存期（PFS）的影响。
入组患者的中位年龄为58岁，38例（48.7%）接受二线及以上治疗。中位无进展生存期（mPFS）和中位总生存期（mOS）分别为7.4个月和13个月。高基线PNI亚组的mPFS和mOS分别为8.8个月和15个月，显著高于低基线PNI亚组（分别为4.7个月和8.2个月；P均＜０.０５）。多因素回归分析显示，低基线PNI是PFS较差（风险比（HR）=0.35，95%可信区间：0.14-０.８５，P=0.020）和OS较差（HR =0.41，95%可信区间：0.17-0.99，P=0.047）的独立预测因素，治疗线数是PFS的独立预测因素。基线BMI与预后无显著相关性。
PNI是预测晚期EC患者免疫治疗预后的一种简单有效的生物标志物，尽管仍需进一步的前瞻性研究。
