Department of Clinical Laboratory, Nanjing Medical University Affiliated Cancer Hospital & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Baizi Ting No.42, Nanjing, 210009, Jiangsu, China.
Clin Transl Oncol. 2024 Aug;26(8):1934-1943. doi: 10.1007/s12094-024-03416-5. Epub 2024 Mar 7.
PURPOSE: Immune checkpoint inhibitors (ICIs) for non-small-cell lung cancer (NSCLC) are on the rise, but unfortunately, only a small percentage of patients benefit from them in the long term. Thus, it is crucial to identify biomarkers that can forecast the efficacy of immunotherapy. METHODS: We retrospectively studied 224 patients with NSCLC who underwent anti-PD-1 therapy. The role of biomarkers and clinical characteristics were assessed in a prognostic model. RESULTS: Only 14.3% of patients had both programmed death ligand 1 (PD-L1) and tumor mutational burden (TMB) outcomes, highlighting the need to investigate more available biomarkers. Our analysis found a correlation between histological PD-L1 TPS and hematological PD-1 expression. Analysis of hematological biomarkers revealed that elevated expression of CD4/CD8 and LYM% are positively associated with effective immunotherapy, while PD-1 on T cells, NLR, and MLR have a negative impact. Moreover, high level of ΔCEA%, CYFRA21-1 and LDH may suggest ineffective ICIs. We also observed that disparate immunotherapy drugs didn't significantly impact prognosis. Lastly, by comparing squamous carcinoma and adenocarcinoma cohorts, ΔCEA%, CD3PD-1, CD4PD-1, and CD4/CD8 are more important in predicting the prognosis of adenocarcinoma patients, while age is more significant for squamous carcinoma patients. CONCLUSION: Our research has yielded encouraging results in identifying a correlation between immunotherapy's response and clinical characteristics, peripheral immune cell subsets, and biochemical and immunological biomarkers. The screened hematological detection panel could be used to forecast an NSCLC patient's response to anti-PD-1 immunotherapy with an accuracy rate of 76.3%, which could help customize suitable therapeutic decision-making.
目的:免疫检查点抑制剂(ICIs)在非小细胞肺癌(NSCLC)中的应用日益增多,但不幸的是,只有一小部分患者能从中长期获益。因此,确定能预测免疫治疗疗效的生物标志物至关重要。
方法:我们回顾性研究了 224 例接受抗 PD-1 治疗的 NSCLC 患者。在预后模型中评估了生物标志物和临床特征的作用。
结果:只有 14.3%的患者同时具有程序性死亡配体 1(PD-L1)和肿瘤突变负担(TMB)结果,这突出表明需要研究更多可用的生物标志物。我们的分析发现组织学 PD-L1 TPS 与血液学 PD-1 表达之间存在相关性。血液生物标志物分析显示,CD4/CD8 和 LYM%升高与有效免疫治疗呈正相关,而 T 细胞上的 PD-1、NLR 和 MLR 则有负面影响。此外,高水平的 ΔCEA%、CYFRA21-1 和 LDH 可能提示 ICI 无效。我们还观察到不同的免疫治疗药物对预后没有显著影响。最后,通过比较鳞状细胞癌和腺癌队列,ΔCEA%、CD3PD-1、CD4PD-1 和 CD4/CD8 在预测腺癌患者的预后方面更为重要,而年龄对鳞状细胞癌患者更为重要。
结论:我们的研究在确定免疫治疗反应与临床特征、外周免疫细胞亚群以及生化和免疫学生物标志物之间的相关性方面取得了令人鼓舞的结果。筛选出的血液学检测面板可用于预测 NSCLC 患者对抗 PD-1 免疫治疗的反应,准确率为 76.3%,有助于制定合适的治疗决策。
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