Department of Otorhinolaryngology, Head and Neck Surgery, Kitasato University School of Medicine, Sagamihara, Japan.
Department of Otorhinolaryngology, Head and Neck Surgery, Kitasato University School of Medicine, Sagamihara, Japan;
Anticancer Res. 2024 Sep;44(9):4057-4072. doi: 10.21873/anticanres.17235.
BACKGROUND/AIM: The predictive role of hematological markers in patients with recurrent or metastatic squamous cell carcinoma of the head and neck (R/M SCCHN) treated with pembrolizumab remains unclear.
We conducted a multicenter retrospective cohort study to investigate the predictive impact of the pre-treatment hematological markers neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), CRP-albumin-lymphocyte (CALLY) index, and the modified Glasgow prognostic score (mGPS) on overall survival (OS) and progression-free survival (PFS) in patients with R/M SCCHN treated with pembrolizumab. From December 2019 to February 2022, 119 and 28 patients were treated with pembrolizumab alone and pembrolizumab plus chemotherapy, respectively. The optimal cut-off point of dichotomized hematological markers was calculated using the area under the receiver operating characteristic curve. Hazard ratios (HRs) and 95% confidence intervals (95%CIs) were estimated using Cox proportional hazard models with adjustment for potential confounders.
In the pembrolizumab monotherapy group, patients with higher NLR, PLR, and mGPS and a lower CALLY index showed significantly shorter OS after adjustment for potential confounders. In addition, all hematological markers examined in this study tended to be associated with clinical response, such as overall response rate or disease control rate (DCR); in particular, a lower CALLY index and higher mGPS were significantly associated with poor DCR. In the pembrolizumab with chemotherapy group, these hematological markers had a similar association with OS but not with clinical response.
Pre-treatment NLR, PLR, CALLY index, and mGPS might be predictive markers of survival in patients with R/M SCCHN treated with pembrolizumab.
背景/目的：在接受派姆单抗治疗的复发性或转移性头颈部鳞状细胞癌（R/M SCCHN）患者中，血液学标志物的预测作用仍不清楚。
我们进行了一项多中心回顾性队列研究，以调查治疗 R/M SCCHN 患者的治疗前血液学标志物中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）、C 反应蛋白-白蛋白-淋巴细胞（CALLY）指数和改良格拉斯哥预后评分（mGPS）对总生存期（OS）和无进展生存期（PFS）的预测影响。2019 年 12 月至 2022 年 2 月，分别有 119 例和 28 例患者接受了派姆单抗单药治疗和派姆单抗联合化疗。使用受试者工作特征曲线下的面积计算二分类血液标志物的最佳截断点。使用 Cox 比例风险模型估计调整潜在混杂因素后的风险比（HR）和 95%置信区间（95%CI）。
在派姆单抗单药治疗组中，调整潜在混杂因素后，NLR、PLR 和 mGPS 较高且 CALLY 指数较低的患者 OS 明显缩短。此外，本研究中检查的所有血液标志物均与临床反应（如总缓解率或疾病控制率[DCR]）呈相关趋势；特别是，较低的 CALLY 指数和较高的 mGPS 与较差的 DCR 显著相关。在派姆单抗联合化疗组中，这些血液标志物与 OS 具有相似的相关性，但与临床反应无关。
治疗前 NLR、PLR、CALLY 指数和 mGPS 可能是接受派姆单抗治疗的 R/M SCCHN 患者生存的预测标志物。
