预测营养指数对接受帕博利珠单抗联合卡铂和紫杉醇/白蛋白紫杉醇治疗的非小细胞肺癌患者的预后预测价值。
Prognostic Potential of the Prognostic Nutritional Index in Non-Small Cell Lung Cancer Patients Receiving Pembrolizumab Combination Therapy with Carboplatin and Paclitaxel/Nab-Paclitaxel.
机构信息
Department of Respiratory Medicine, Comprehensive Cancer Center, International Medical Center, Saitama Medical University, Saitama, Japan.
Division of Respiratory Medicine, Gunma Prefectural Cancer Center, Ota, Japan.
出版信息
Oncology. 2024;102(1):30-42. doi: 10.1159/000533604. Epub 2023 Aug 18.
INTRODUCTION
Pembrolizumab (Pemb) therapy in conjunction with carboplatin and paclitaxel (PTX)/nab-PTX has been efficacious in treating non-small cell lung cancer (NSCLC). However, the response predictors of this combination therapy (Pemb-combination) remain undetermined. We aimed to evaluate whether Glasgow prognostic score (GPS), neutrophil-to-lymphocyte ratio (NLR), body mass index (BMI), platelet-to-lymphocyte ratio (PLR), and prognostic nutritional index (PNI) are potential factors in prognosticating the response to Pemb-combination therapy in advanced NSCLC patients.
METHODS
We retrospectively recruited 144 NSCLC patients receiving first-line treatment with Pemb-combination therapy from 13 institutions between December 1, 2018, and December 31, 2020. GPS, NLR, BMI, PLR, and PNI were assessed for their efficacy as prognostic indicators. Cox proportional hazard models and the Kaplan-Meier method were used to compare the progression-free survival (PFS) and overall survival (OS) of the patients.
RESULTS
The treatment exhibited a response rate of 63.1% (95% confidence interval [CI]: 55.0-70.6%). Following Pemb-combination administration, the median PFS and OS were 7.3 (95% CI: 5.3-9.4) and 16.5 (95% CI: 13.9-22.1) months, respectively. Contrary to PNI, NLR, GPS, BMI, and PLR did not display substantially different PFS in univariate analysis. However, multivariate analysis did not identify PNI as an independent prognostic factor for PFS. Furthermore, univariate analysis revealed that GPS, BMI, and PLR exhibited similar values for OS but not NLR and PNI. Patients with PNI ≥45 were predicted to have better OS than those with PNI <45 (OS: 23.4 and 13.9 months, respectively, p = 0.0028). Multivariate analysis did not establish NLR as an independent prognostic factor for OS.
CONCLUSION
The PNI evidently predicted OS in NSCLC patients treated with Pemb-combination as first-line therapy, thereby validating its efficiency as a prognostic indicator of NSCLC.
简介
帕博利珠单抗（Pemb）联合卡铂和紫杉醇（PTX）/nab-PTX 已被证明可有效治疗非小细胞肺癌（NSCLC）。然而，这种联合治疗（Pemb 联合）的反应预测因素仍未确定。我们旨在评估格拉斯哥预后评分（GPS）、中性粒细胞与淋巴细胞比值（NLR）、体重指数（BMI）、血小板与淋巴细胞比值（PLR）和预后营养指数（PNI）是否为预测晚期 NSCLC 患者对 Pemb 联合治疗反应的潜在因素。
方法
我们回顾性招募了 144 名 NSCLC 患者，这些患者于 2018 年 12 月 1 日至 2020 年 12 月 31 日期间在 13 家机构接受 Pemb 联合一线治疗。评估 GPS、NLR、BMI、PLR 和 PNI 作为预后指标的疗效。Cox 比例风险模型和 Kaplan-Meier 法用于比较患者的无进展生存期（PFS）和总生存期（OS）。
结果
该治疗的反应率为 63.1%（95%置信区间[CI]：55.0-70.6%）。接受 Pemb 联合治疗后，中位 PFS 和 OS 分别为 7.3（95%CI：5.3-9.4）和 16.5（95%CI：13.9-22.1）个月。与 PNI 相反，NLR、GPS、BMI 和 PLR 在单因素分析中并未显示出明显不同的 PFS。然而，多因素分析并未确定 PNI 是 PFS 的独立预后因素。此外，单因素分析显示，GPS、BMI 和 PLR 对 OS 的预测价值相似，但 NLR 和 PNI 则不然。PNI≥45 的患者的 OS 预测值优于 PNI<45 的患者（OS：分别为 23.4 和 13.9 个月，p=0.0028）。多因素分析未确定 NLR 是 OS 的独立预后因素。
结论
PNI 明显预测了接受 Pemb 联合一线治疗的 NSCLC 患者的 OS，从而验证了其作为 NSCLC 预后指标的有效性。
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