Zheng Xixi, Zhou Lili, Shi Hui, An Juan, Xu Weiran, Ding Xiaosheng, Hua Yichun, Shi Weiwei, Li Xiaoyan
Department of Oncology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Department of Oncology, PLA General Hospital, Beijing, China.
Thorac Cancer. 2024 Oct;15(28):2029-2037. doi: 10.1111/1759-7714.15406. Epub 2024 Aug 27.
Patients with programmed cell death-ligand 1 (PD-L1) ≥50% metastatic non-small cell lung cancer (NSCLC) treated with first-line immunotherapy showed heterogeneous tumor responses. In this study, we investigated the clinical and immune-inflammatory markers distinguishing patients with metastatic NSCLC achieving high depth of tumor response (HDPR) from those with non-high depth of response (NHDPR). The impact of clinical features on the prognosis of patients with PD-L1 ≥50% were further clarified.
The clinical characteristics and immune-inflammatory markers of 17 patients with PD-L1 ≥50% metastatic NSCLC at Beijing Tiantan Hospital between July 2020 and December 2023 were retrospectively analyzed.
Among the 17 patients, seven (41.2%) patients achieved HDPR (range: -50%, -72%) and 10 (58.8%) patients achieved NHDPR (range: -13%, -45%). Below normal CD4 + T lymphocytes/CD8 + T lymphocytes (CD4/CD8) ratio (p = 0.01) and oncogenes and/or tumor suppressor gene mutations (TP53/KRAS/EGFR) (p = 0.001) were found enriched for NHDPR compared with HDPR. With a median follow-up of 26.0 months (range: 17.2-34.8 months), the median progression-free survival (PFS) following first-line immunotherapy and overall survival (OS) were 9.0 months (95% CI: 5.0-13.0) and not reached (NR), respectively. The neutrophil-to-lymphocyte ratio (NLR) was identified as an independent prognostic factor on first-line PFS. Patients with an NLR ≥4 exhibited a shorter median PFS (7.0 months vs. NR; p = 0.033; 95% CI: 1.2-80.2) than those with an NLR <4 following first-line immunotherapy.
Among patients with PD-L1 ≥50% metastatic NSCLC who received first-line immunotherapy, a lower CD4/CD8 ratio and the presence of genes mutations showed a diminished tumor response and a higher NLR ratio exhibited a worse median PFS.
程序性细胞死亡配体1（PD-L1）≥50%的转移性非小细胞肺癌（NSCLC）患者接受一线免疫治疗后显示出异质性肿瘤反应。在本研究中，我们调查了区分转移性NSCLC患者达到高肿瘤反应深度（HDPR）和未达到高反应深度（NHDPR）患者的临床和免疫炎症标志物。进一步阐明了临床特征对PD-L1≥50%患者预后的影响。
回顾性分析了2020年7月至2023年12月在北京天坛医院就诊的17例PD-L1≥50%的转移性NSCLC患者的临床特征和免疫炎症标志物。
17例患者中，7例（41.2%）达到HDPR（范围：-50%，-72%），10例（58.8%）达到NHDPR（范围：-13%，-45%）。与HDPR相比，NHDPR患者中低于正常的CD4 + T淋巴细胞/CD8 + T淋巴细胞（CD4/CD8）比值（p = 0.01）以及癌基因和/或肿瘤抑制基因突变（TP53/KRAS/EGFR）（p = 0.001）更为富集。中位随访26.0个月（范围：17.2 - 34.8个月），一线免疫治疗后的中位无进展生存期（PFS）和总生存期（OS）分别为9.0个月（95%CI：5.0 - 13.0）和未达到（NR）。中性粒细胞与淋巴细胞比值（NLR）被确定为一线PFS的独立预后因素。一线免疫治疗后，NLR≥4的患者中位PFS（7.0个月 vs. NR；p = 0.033；95%CI：1.2 - 80.2）比NLR＜4的患者短。
在接受一线免疫治疗的PD-L1≥50%的转移性NSCLC患者中，较低的CD4/CD8比值和基因突变的存在表明肿瘤反应减弱，较高的NLR比值表明中位PFS较差。
