Du Jiya, Zhang Qian, Tian Le, Chen Yishan, Tian Ye, Dempke Wolfram C M, Arasanz Hugo, Soo Ross Andrew, Zhou Zhiguo, Meng Qingju, Liu Yibing
Department of Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China.
Department of Medical Oncology, Affiliated Hospital of Hebei University; Hebei Key Laboratory of Cancer Radiotherapy and Chemotherapy, Baoding, China.
J Thorac Dis. 2024 Dec 31;16(12):8669-8683. doi: 10.21037/jtd-24-1826. Epub 2024 Dec 28.
Lung cancer is the main cause of cancer death in the world, with small-cell lung cancer (SCLC) accounting for about 10-15% of all lung cancers. Although programmed cell death protein 1 (PD-1)/programmed cell death ligand 1 (PD-L1) inhibitors represent a major breakthrough in SCLC treatment, only a minority of patients will benefit and there is still a lack of accurate biomarkers to guide clinical application. Inflammation plays a crucial role in tumorigenesis, tumor development, metastasis, and drug resistance, but there is limited research on the predictive value of these inflammatory indicators in SCLC. The purpose of our study was to determine the influence of prognostic nutritional index (PNI), systemic immune inflammation (SII), and other indexes on the efficacy and prognosis of patients with SCLC treated with PD-1/PD-L1 inhibitors.
A total of 700 patients of SCLC treated with PD-1/PD-L1 inhibitors in the Fourth Hospital of Hebei Medical University from January 2019 to January 2023 were retrospectively analysed. Among these patients, 246 were included after the inclusion and exclusion criteria were applied. The basic clinical data of patients were collected, included age, sex, PD-1 or PD-L1 inhibitors and so on. The neutrophil:lymphocyte ratio (NLR), platelet:lymphocyte ratio (PLR), PNI, SII, and monocyte:lymphocyte ratio (MLR) were calculated. SPSS 27 software was employed for statistical analysis. As of 1st March 2023, all patients had received a post-diagnosis follow-up. The median follow-up time was 11.7 months.
Among the 246 patients with SCLC receiving PD-1/PD-L1 inhibitor treatment. the overall response rate and disease control rate were 47.6% and 89.8%, respectively. Median progression-free survival (PFS) and median overall survival (OS) were 9.0 months and 21.4 months, respectively. Multivariate analysis showed that MLR [hazard ratio (HR) =0.631; P=0.01], and platelet (PLT) count (HR =1.641; P=0.009) were independent risk factors for PFS. NLR (HR =0.566, P=0.01) and lactate dehydrogenase (LDH) (HR =0.446; P=0.002) were independent risk factors for OS.
Among patients with SCLC treated with PD-1/PD-L1 inhibitors, those with high MLR and low PLT had shorter PFS, whilst patients with high NLR and LDH had a shorter OS. NLR and LDH may be used as prognostic biomarkers patients with SCLC treated with PD-1/PD-L1 inhibitors. The promising clinical application of NLR and LDH in efficacy prognostic indicators and beneficiary selection for SCLC immunotherapy is highlighted.
肺癌是全球癌症死亡的主要原因，小细胞肺癌（SCLC）约占所有肺癌的10%-15%。尽管程序性细胞死亡蛋白1（PD-1）/程序性细胞死亡配体1（PD-L1）抑制剂是SCLC治疗的一项重大突破，但只有少数患者会从中受益，且仍缺乏准确的生物标志物来指导临床应用。炎症在肿瘤发生、发展、转移和耐药中起关键作用，但关于这些炎症指标在SCLC中的预测价值的研究有限。我们研究的目的是确定预后营养指数（PNI）、全身免疫炎症（SII）及其他指标对接受PD-1/PD-L1抑制剂治疗的SCLC患者疗效和预后的影响。
回顾性分析2019年1月至2023年1月在河北医科大学第四医院接受PD-1/PD-L1抑制剂治疗的700例SCLC患者。其中，246例患者经过纳入和排除标准筛选后被纳入研究。收集患者的基本临床资料，包括年龄、性别、PD-1或PD-L1抑制剂等。计算中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）、PNI、SII和单核细胞与淋巴细胞比值（MLR）。采用SPSS 27软件进行统计分析。截至2023年3月1日，所有患者均接受了确诊后的随访。中位随访时间为11.7个月。
在246例接受PD-1/PD-L1抑制剂治疗的SCLC患者中，总缓解率和疾病控制率分别为47.6%和89.8%。中位无进展生存期（PFS）和中位总生存期（OS）分别为9.0个月和21.4个月。多因素分析显示，MLR[风险比（HR）=0.631；P=0.01]和血小板（PLT）计数（HR =1.641；P=0.009）是PFS的独立危险因素。NLR（HR =0.566，P=0.01）和乳酸脱氢酶（LDH）（HR =0.446；P=0.002）是OS的独立危险因素。
在接受PD-1/PD-L1抑制剂治疗的SCLC患者中，MLR高且PLT低的患者PFS较短，而NLR和LDH高的患者OS较短。NLR和LDH可作为接受PD-1/PD-L1抑制剂治疗的SCLC患者的预后生物标志物。强调了NLR和LDH在SCLC免疫治疗疗效预后指标和受益人群选择方面具有广阔的临床应用前景。
