Department of Medical Oncology, University of Health Sciences, Bursa City Education and Research Hospital, 16059 Bursa, Turkey.
Department of Internal Medicine, University of Health Sciences, Bursa City Education and Research Hospital, 16059 Bursa, Turkey.
Medicina (Kaunas). 2024 Nov 1;60(11):1792. doi: 10.3390/medicina60111792.
: In this study, we evaluated the impact of seven immune indexes on treatment response and survival outcomes in advanced non-small-cell lung cancer (NSCLC) patients receiving second-line and subsequent nivolumab treatment under real-life conditions. : The pan-immune inflammation value (PIV), systemic immune inflammation value (SII), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), derived neutrophil-to-lymphocyte ratio (d-NLR), and prognostic nutritional index (PNI) were calculated. All immune indexes were classified as low and high based on cut-off values. Kaplan-Meier and Cox hazard models were used for survival analysis. : The median follow-up was 22.0 months (6.0-96.0). The median overall survival (OS) was 30.0 months and the median progression-free survival (PFS) was 7.0 months. In the univariate analysis, comorbidity ( = 0.03) and nivolumab use for more than eight cycles ( < 0.0001) were associated with an increase in PFS, while smoking history ( < 0.005) and d-NLR ( < 0.05) were more effective regarding OS. Patients who received more than eight cycles of nivolumab had longer median PFS (4 vs. 19 months, < 0.001) and OS (23 vs. 43 months, < 0.001). We found longer median OS in the PLR (45.7 vs. 75.4 months; = 0.05), PIV (53.0 vs. 66.4 months; = 0.19), SII (50.0 vs. 71.9 vs. months, = 0.19), and NLR (49.9 vs. 74.55 months, = 0.10) indexes in nivolumab long-term users (high vs. low groups, respectively). In short-term users of nivolumab, only d-NLR median OS (high vs. low, 19 vs. 75.2 months, = 0.07) was different. Complete and partial response rates to nivolumab treatment were higher in the PNI-high group ( = 0.04). : In these real-life data, we determined that the PLR, PIV, SII, and NLR indexes were effective in the prognosis of patients who received PD1 inhibitor nivolumab for a long time, and the d-NLR index was effective in those who developed progression in a short time. We found that the PNI was effective in patients who responded well to ICI treatment.
在这项研究中，我们评估了在真实环境下，接受二线及后续纳武利尤单抗治疗的晚期非小细胞肺癌（NSCLC）患者的七种免疫指标对治疗反应和生存结局的影响。计算了全免疫炎症值（PIV）、全身免疫炎症值（SII）、中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）、单核细胞与淋巴细胞比值（MLR）、衍生中性粒细胞与淋巴细胞比值（d-NLR）和预后营养指数（PNI）。所有免疫指标均根据截断值分为低和高两类。采用 Kaplan-Meier 和 Cox 风险模型进行生存分析。中位随访时间为 22.0 个月（6.0-96.0）。中位总生存期（OS）为 30.0 个月，中位无进展生存期（PFS）为 7.0 个月。单因素分析显示，合并症（ = 0.03）和纳武利尤单抗使用超过 8 个周期（ < 0.0001）与 PFS 延长相关，而吸烟史（ < 0.005）和 d-NLR（ < 0.05）与 OS 更相关。接受纳武利尤单抗超过 8 个周期的患者中位 PFS（4 个月 vs. 19 个月， < 0.001）和 OS（23 个月 vs. 43 个月， < 0.001）更长。我们发现 PLR（45.7 个月 vs. 75.4 个月； = 0.05）、PIV（53.0 个月 vs. 66.4 个月； = 0.19）、SII（50.0 个月 vs. 71.9 个月， = 0.19）和 NLR（49.9 个月 vs. 74.55 个月， = 0.10）指标在纳武利尤单抗长期使用者（高 vs. 低组）中具有更长的中位 OS。在纳武利尤单抗的短期使用者中，只有 d-NLR 中位 OS（高 vs. 低，19 个月 vs. 75.2 个月， = 0.07）有所不同。完全缓解和部分缓解率在 PNI 高组较高（ = 0.04）。在这些真实数据中，我们确定在接受 PD1 抑制剂纳武利尤单抗长期治疗的患者中，PLR、PIV、SII 和 NLR 指标对预后有效，而 d-NLR 指标在短期内进展的患者中有效。我们发现 PNI 对免疫检查点抑制剂（ICI）治疗反应良好的患者有效。
