Wang Fang, Jiang Chang, He Wenzhuo, Li Heping, Guo Gui-Fang, Xu Lixia
Department of Oncology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, People's Republic of China.
State Key Laboratory of Oncology in South China, The Sun Yat-Sen University Cancer Center Guangzhou, Guangzhou, Guangdong Province, People's Republic of China.
Immunotargets Ther. 2024 Oct 16;13:541-557. doi: 10.2147/ITT.S471502. eCollection 2024.
The response of patients with biliary tract carcinoma (BTC) to immunotherapy varies widely, and there is an urgent need for biological indicators. The predictive value of inflammation based score (IBS) for the efficacy of immunotherapy in patients with BTC remains unclear, as the evidence is inconsistent. This study aimed to comprehensively examine the predictive value of IBS in peripheral blood on the survival of BTC patients receiving immunotherapy.
We retrospectively assessed 118 patients with advanced BTC who received anti-PD-1 therapy in the first or second line in two medical centers. The Kaplan-Meier, time-dependent ROC, and Harrell's concordance index (C-index) were applied to analyze the predictive value of 13 reported peripheral blood IBS.
All 13 IBS were identified as significant prognostic factors for OS in univariate analysis. Pan-immune-inflammation value (PIV) (p=0.005), PILE (composed of PIV, lactate dehydrogenase and Eastern Cooperative Oncology Group performance status) (=0.033), neutrophil-to-lymphocyte ratio (NLR) (=0.003), platelet-to-lymphocyte ratio (PLR) (<0.001), lymphocyte-to-monocyte ratio (LMR) (=0.006), systemic immune inflammation index (SII) (=0.039), CRP-to-albumin ratio (CAR) (=0.025), and Albumin-NLR (=0.008) were identified as independent prognostic factors for OS in multivariate analysis. PIV and PILE scores were superior to other scores, according to time-dependent ROC curves, and their superiority became more pronounced after the 12-month time point. C-index analysis showed PIV (C-index 0.62, 95% CI: 0.55, 0.68) and PILE (C-index 0.62, 95% CI: 0.55, 0.70), both superior to other IBS.
PIV and PILE scores are independent predictors of OS in patients with BTC after immunotherapy and are superior to other IBS. PIV and PILE may be able to help screen out patients with advanced BTC who are less likely to benefit from anti-PD-1 monotherapy. Due to the retrospective nature of this analysis, the predictive value of PIV and PILE require validation in further prospective studies.
胆管癌（BTC）患者对免疫疗法的反应差异很大，迫切需要生物学指标。基于炎症的评分（IBS）对BTC患者免疫治疗疗效的预测价值仍不明确，因为证据并不一致。本研究旨在全面检验外周血IBS对接受免疫治疗的BTC患者生存的预测价值。
我们回顾性评估了在两个医疗中心接受一线或二线抗PD-1治疗的118例晚期BTC患者。应用Kaplan-Meier法、时间依赖性ROC曲线和Harrell一致性指数（C指数）分析13种已报道的外周血IBS的预测价值。
在单因素分析中，所有13种IBS均被确定为总生存期（OS）的显著预后因素。全免疫炎症值（PIV）（p=0.005）、PILE（由PIV、乳酸脱氢酶和东部肿瘤协作组体能状态组成）（=0.033）、中性粒细胞与淋巴细胞比值（NLR）（=0.003）、血小板与淋巴细胞比值（PLR）（<0.001）、淋巴细胞与单核细胞比值（LMR）（=0.006）、全身免疫炎症指数（SII）（=0.039）、CRP与白蛋白比值（CAR）（=0.025）以及白蛋白-NLR（=0.008）在多因素分析中被确定为OS的独立预后因素。根据时间依赖性ROC曲线，PIV和PILE评分优于其他评分，且在12个月时间点后其优势更加明显。C指数分析显示PIV（C指数0.62，95%CI：0.55，0.68）和PILE（C指数0.62，95%CI：0.55，0.70）均优于其他IBS。
PIV和PILE评分是BTC患者免疫治疗后OS的独立预测指标，且优于其他IBS。PIV和PILE可能有助于筛选出不太可能从抗PD-1单药治疗中获益的晚期BTC患者。由于本分析的回顾性性质，PIV和PILE的预测价值需要在进一步的前瞻性研究中进行验证。
