免疫检查点抑制剂治疗晚期NSCLC的临床价值

Clinical value of anti-PD-1/PD-L1 immunotherapy in patients with advanced non-small cell lung cancer

目的探讨肿瘤组织PD-L1表达及外周血炎性复合指标与驱动基因野生型晚期NSCLC患者的免疫治疗联合化疗疗效及预后的相关性。方法收集行单纯化疗及免疫治疗联合化疗的65例晚期野生型NSCLC患者临床资料,根据治疗方案分为化疗组(A组)、免疫治疗联合化疗组(B组)。结果B组较A组患者的有效率更高(43.8%)、无进展生存时间更长(7.7月),但两组不良反应发生率无明显差异;治疗前PD-L1表达与患者病理类型有关(P=0.030),与免疫治疗疗效无关。A组中:性别、远处转移数、治疗后PLR水平变化、治疗前LMR水平是患者PFS的影响因素(P<0.05)。B组中:治疗后PLR水平变化是患者PFS的影响因素(P=0.014)。多因素分析提示性别、治疗后PLR水平变化及治疗前LMR水平是A组患者PFS的独立预测因素;治疗后PLR水平变化是B组患者PFS的独立预测因素。结论驱动基因野生型晚期NSCLC患者经过免疫治疗联合化疗可提高有效率、延长PFS。监测患者外周血炎性复合指标一定程度上可预测晚期NSCLC患者的疗效。

Objective To investigate the correlation between PD-L1 expression,the peripheral blood inflammatory complex indexes and the curative effect,prognosis of immunotherapy combined with chemotherapy in patients with advanced NSCLC and negative driven genes.Methods 65 advanced NSCLC patients with negative driven genes who underwent chemotherapy and immunotherapy combined with chemotherapy were retrospectively analyzed.According to the treatment plan,they were divided into the chemotherapy group(the group A),and the immunotherapy plus chemotherapy group(the group B).Results Compared with the group A,the higher response rate(43.8%)and longer PFS(7.7m)were observed in the group B.However,there was no significant difference in the incident of adverse reactions.Pre-therapy PD-L1 expression was correlated with pathology(P=0.030),while it was not significantly correlated with the curative effect of immunotherapy.Gender,distant metastasis,the change of PLR level after therapy and LMR level before therapy were factors in PFS of patients in the group A(P<0.05).However,the change of PLR level after therapy was the factor in PFS of patients in the group B(P=0.014).Multivariate analysis showed that gender,the change of PLR level after therapy and LMR level before therapy were independent prognostic factors for PFS of patients in the group A,while the change of PLR level was identified as an independent prognostic factor for PFS of patients in the group B.Conclusion The response rate and PFS of patients with advanced NSCLC and negative driven genes are improved after immunotherapy combined with chemotherapy.The peripheral blood inflammatory complex indexes can predict the curative effect of therapy in the advanced NSCLC patients to a certain extent.