Lin Siyi, Liu Yanyang, Zhao Feng, Jiang Qiuxiao, Yang Shuyu, Zhang He, Feng Bin, Gan Wei
（ 610041） Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu 610041, China.
· （ 621000） The Third Hospital of Mianyang and Sichuan Mental Health Center, Mianyang 621000, China.
Sichuan Da Xue Xue Bao Yi Xue Ban. 2025 Mar 20;56(2):514-520. doi: 10.12182/20250360104.
To investigate the clinical features of thyroid dysfunction in lung cancer patients treated with programmed cell death receptor-1 (PD-1) or programmed cell death receptor-ligand 1 (PD-L1) and their value for predicting therapeutic efficacy.
Lung cancer patients treated with PD-1/PD-L1 inhibitors at West China Hospital, Sichuan University between March 2018 and September 2022 were retrospectively enrolled. Data concerning the medical records, therapeutic efficacy, and thyroid function indicators of the patients were retrieved from the hospital electronic medical record information system. The data were then analyzed to identify risk factors and predictive factors for immune-related adverse events (irAEs) of the thyroid. The predictive value of thyroid irAEs for treatment efficacy and prognosis was assessed. Objective response rate (ORR) was defined as the indicator for therapeutic efficacy and progression-free survival (PFS) was defined as the prognostic indicator.
A total of 368 lung cancer patients were enrolled. Among them, 31.5% (116/368) developed thyroid irAEs. According to the results of logistic regression analysis, baseline thyroid stimulating hormone (TSH) concentration and baseline positive results for thyroglobulin antibody (TGAb) and thyroid peroxidase antibody (TPOAb) were risk factors for thyroid dysfunction caused by PD-1/PD-L1 inhibitors. Among the three measures, baseline TPOAb concentration demonstrated good predictive value for thyroid irAEs, with an area under the receiver-operating characteristic (ROC) curve (AUC) of 0.745. Patients with thyroid irAEs had a longer median PFS (16.0 months vs. 9.7 months, < 0.001) and a higher ORR (55.2% vs. 34.9%, < 0.001) compared to those without thyroid irAEs. Patients with thyroid irAEs had a better ORR than those without thyroid irAEs did. It was more likely for patients with thyroid irAEs to achieve an objective response compared to those without thyroid irAEs (odds ratio [OR] = 2.29; 95% CI, 1.46-3.60).
In lung cancer patients treated with the PD-1/PD-L1 inhibitors, the TPOAb antibody demonstrates good predictive value for thyroid irAEs. Patients who develop thyroid irAEs have better treatment outcomes and prognosis.
探讨程序性死亡受体1（PD-1）或程序性死亡受体配体1（PD-L1）治疗的肺癌患者甲状腺功能障碍的临床特征及其对预测治疗疗效的价值。
回顾性纳入2018年3月至2022年9月在四川大学华西医院接受PD-1/PD-L1抑制剂治疗的肺癌患者。从医院电子病历信息系统中检索患者的病历、治疗疗效及甲状腺功能指标等数据。然后对数据进行分析，以确定甲状腺免疫相关不良事件（irAEs）的危险因素和预测因素。评估甲状腺irAEs对治疗疗效和预后的预测价值。客观缓解率（ORR）定义为治疗疗效指标，无进展生存期（PFS）定义为预后指标。
共纳入368例肺癌患者。其中，31.5%（116/368）发生甲状腺irAEs。根据逻辑回归分析结果，基线促甲状腺激素（TSH）浓度、甲状腺球蛋白抗体（TGAb）和甲状腺过氧化物酶抗体（TPOAb）基线阳性结果是PD-1/PD-L1抑制剂所致甲状腺功能障碍的危险因素。在这三项指标中，基线TPOAb浓度对甲状腺irAEs具有良好的预测价值，受试者操作特征（ROC）曲线下面积（AUC）为0.745。与无甲状腺irAEs的患者相比，发生甲状腺irAEs的患者中位PFS更长（16.0个月对9.7个月，P<0.001），ORR更高（55.2%对34.9%，P<0.001）。发生甲状腺irAEs的患者ORR优于无甲状腺irAEs的患者。与无甲状腺irAEs的患者相比，发生甲状腺irAEs的患者更有可能获得客观缓解（比值比[OR]=2.29；95%可信区间，1.46-3.60）。
在接受PD-1/PD-L1抑制剂治疗的肺癌患者中，TPOAb抗体对甲状腺irAEs具有良好的预测价值。发生甲状腺irAEs的患者治疗效果和预后更佳。
