Background: Lung cancer is the leading cause of cancer-related death, of which non-small cell lung cancer (NSCLC) is the most common type. Immune checkpoint inhibitors (ICIs) have now become one of the main treatments for advanced NSCLC. This paper retrospectively investigated the effect of peripheral blood inflammatory indexes on the efficacy of immunotherapy and survival of patients with advanced non-small cell lung cancer, in order to find strategies to guide immunotherapy in NSCLC.
Methods: Patients with advanced non-small cell lung cancer who were hospitalized in The Affiliated Cancer Hospital of Nanjing Medical University from October 2018 to August 2019 were selected to receive anti-PD-1 (pembrolizumab, sintilimab or toripalimab) monotherapy or combination regimens. And were followed up until 10 December 2020, and the efficacy was evaluated according to RECIST1.1 criteria. Progression-free survival (PFS) and overall survival (OS) were followed up for survival analysis. A clinical prediction model was constructed to analyze the predictive value of neutrophil-to-lymphocyte ratio (NLR) based on NLR data at three different time points: before treatment, 6 weeks after treatment and 12 weeks after treatment (0w, 6w and 12w), and the accuracy of the model was verified.
Results: 173 patients were finally included, all of whom received the above treatment regimen, were followed up for a median of 19.7 months. The objective response rate (ORR) was 27.7% (48/173), the disease control rate (DCR) was 89.6% (155/173), the median PFS was 8.3 months (7.491-9.109) and the median OS was 15.5 months (14.087-16.913). The chi-square test and logistic multi-factor analysis showed that NLR6w was associated with ORR and NLR12w was associated with ORR and DCR. Further Cox regression analysis showed that NLR6w and NLR12w affected PFS and NLR0w, NLR6w and NLR12w were associated with OS.
Conclusions: In patients with advanced non-small cell lung cancer, NLR values at different time points are valid predictors of response to immunotherapy, and NLR <3 is often associated with a good prognosis.
【中文题目：外周血炎症指标作为预测性指标在晚期 非小细胞肺癌免疫治疗中的应用】 【中文摘要：背景与目的 肺癌是癌症相关死亡最主要的病因，其中非小细胞肺癌（non small cell lung cancer, NSCLC）是最常见的类型。目前免疫检查点抑制剂（immune checkpoint inhibitors, ICIs）已经成为晚期NSCLC主要的治疗方法之一。本文回顾性研究了外周血炎症指标对晚期NSCLC患者免疫治疗疗效及生存预后的影响，以寻找指导NSCLC免疫治疗的策略。方法 选取2018年10月-2019年8月于南京医科大学附属肿瘤医院住院治疗的晚期NSCLC患者，均接受抗PD-1（Pembrolizumab、Sintilimab或Toripalimab）单药或者联合方案治疗。随访至2020年12月10日，根据RECIST1.1标准评价疗效，分析影响疗效的显著变量，并随访无进展生存期（progression-free survival, PFS）及总生存期（overall survival, OS）进行生存分析。根据治疗前、治疗后6周、治疗后12周（0 w、6 w、12 w）三个不同时间点中性粒细胞计数与淋巴细胞计数比值（neutrophil-to-lymphocyte ratio, NLR）数据构建临床预测模型分析NLR的预测价值，并验证模型准确性。结果 最终纳入173例患者，所有患者均接受上述治疗方案，中位随访时间19.7个月。客观缓解率（objective response rate, ORR）27.7%（48/173），疾病控制率（disease control rate, DCR）89.6%（155/173），中位PFS为8.3个月（7.491-9.109），中位OS为15.5个月（14.087-16.913）。χ2检验及Logistic多因素分析显示NLR6w与ORR相关，NLR12w与ORR、DCR相关，进一步Cox回归分析显示NLR6w和NLR12w影响PFS，NLR0w、NLR6w和NLR12w与OS相关。结论 在晚期NSCLC患者中，不同时间点的NLR数值是免疫治疗反应的有效预测因子，并且NLR<3往往与良好的预后相关。】 【中文关键词：肺肿瘤；免疫检查点抑制剂；中性粒细胞与淋巴细胞计数比值；列线图】.
Keywords: Immune checkpoint inhibitors; Lung neoolasms; Neutrophil-to-lymphocyte ratio; Nomogram.