Li Shijun, Zhang Cuicui, Wang Xinyue, Wang Jing, Li Kai
Department of Oncology, The Fourth Center Clinical College of Tianjin Medical University, Tianjin Fourth Centre Hospital, The Fourth Central Hospital Affiliated to Nankai University, Tianjin, China.
Department of Thoracic Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.
J Thorac Dis. 2025 May 30;17(5):3456-3463. doi: 10.21037/jtd-2024-2198. Epub 2025 May 28.
Immune checkpoint inhibitors (ICIs), principally represented by programmed death 1/programmed death ligand 1 (PD-1/PD-L1) inhibitors have been used in the first-line treatment of advanced lung cancer by Chinese Society of Clinical Oncology (CSCO) since 2018. Biomarkers like PD-L1 and tumor mutational burden (TMB) help to differentiate patients who benefited from ICI therapy. This study aimed to confirm and assess the predictive value of inflammatory markers in advanced lung cancer patients with the treatment of ICIs plus chemotherapy in the real world. The parameters of patients were collected in this retrospective study. Inflammatory markers were mainly calculated at different treatment periods. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated with the univariate and multivariate Cox proportional hazard model. The Cox multivariate regression analysis indicated that a higher eosinophil-to-lymphocyte ratio (ELR) (HR 0.399, 95% CI: 0.189-0.842, P=0.02) and a higher monocyte-to-lymphocyte ratio (MLR) (HR 2.162, 95% CI: 1.116-4.191, P=0.02) at the time of maximizing therapeutic benefits, a higher lactate dehydrogenase (LDH) (HR 2.456, 95% CI: 1.334-4.523, P=0.004) at the time of disease progression were independent risk factors. A higher ELR and a lower MLR at maximizing therapeutic benefits and a lower LDH at disease progression were positive protectors for the progression-free survival (PFS) of advanced lung cancer treated with ICI combined with platinum-based chemotherapy.
免疫检查点抑制剂（ICI），主要以程序性死亡蛋白1/程序性死亡配体1（PD-1/PD-L1）抑制剂为代表，自2018年起已被中国临床肿瘤学会（CSCO）用于晚期肺癌的一线治疗。PD-L1和肿瘤突变负荷（TMB）等生物标志物有助于鉴别从ICI治疗中获益的患者。本研究旨在在现实世界中确认并评估炎症标志物在接受ICI加化疗治疗的晚期肺癌患者中的预测价值。在这项回顾性研究中收集了患者的参数。炎症标志物主要在不同治疗阶段进行计算。采用单因素和多因素Cox比例风险模型计算风险比（HR）和95%置信区间（CI）。Cox多因素回归分析表明，在治疗获益最大化时，较高的嗜酸性粒细胞与淋巴细胞比值（ELR）（HR 0.399，95%CI：0.189-0.842，P=0.02）和较高的单核细胞与淋巴细胞比值（MLR）（HR 2.162，95%CI：1.116-4.191，P=0.02），以及在疾病进展时较高的乳酸脱氢酶（LDH）（HR 2.456，95%CI：1.334-4.523，P=0.004）是独立危险因素。在治疗获益最大化时较高的ELR和较低的MLR，以及在疾病进展时较低的LDH是接受ICI联合铂类化疗的晚期肺癌无进展生存期（PFS）的阳性保护因素。
