外周血中性粒细胞与淋巴细胞比值预测晚期非小细胞肺癌免疫治疗疗效的价值

The value of neutrophil-to-lymphocyte ratio(NLR)in predicting the efficacy of advanced non-small cell lung cancer treated with immunotherapy

目的:探讨外周血中性粒细胞与淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)预测晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)免疫治疗近期疗效的可行性。方法:回顾分析2018年08月至2019年12月收治的60例一线及以上治疗进展后应用帕博丽珠单抗治疗的NSCLC患者的近期疗效及NLR水平变化。根据ROC曲线,将患者治疗前NLR值分为NLR<2.605组和NLR≥2.605组,分析两组患者治疗前NLR水平,以及治疗前后NLR水平动态变化与患者近期疗效相关性。采用RECIST1.1评价疗效。结果:共计60例患者纳入统计,NLR<2.605组患者41例,NLR≥2.605组患者19例,两组间基本资料差异均无统计学意义(P>0.05)。NLR<2.605组的疾病控制率(disease control rate,DCR)为82.9%,明显优于NLR≥2.605组的26.3%,差异有统计学意义(P<0.05)。两组患者治疗2个周期后NLR升高≥30%患者的DCR明显低于NLR升高不明显或下降患者(P<0.05)。结论:外周血NLR水平以及治疗过程中NLR动态变化,可预测非小细胞肺癌免疫治疗的近期疗效。

Objective:To evaluate the value of peripheral blood neutrophil-to-lymphocyte ratio(NLR)in evaluating the short-term effects of patients with advanced non-small cell lung cancer(NSCLC)treated with immunotherapy.Methods:From August 2018 to December 2019,a total of 60 patients with advanced NSCLC treated with pembrolizumab as second and further-line treatment were collected.Of these patients,receiver operating characteristic(ROC)curve analysis was used to confirm the cut-off value,and patients were stratified into NLR<2.605 and NLR≥2.605 groups.The correlation between the NLR level was analysed.The dynamic change of NLR level before and after treatment and the short-time efficacy were analysed.The efficacy was evaluated by RECIST 1.1.Results:A total of 60 patients were included in the statistics.The number in NLR<2.605 group had 41 patients and NLR≥2.605 group had 19 patients.For the 60 patients,basic data difference between the two groups had no statistical significance(P>0.05).NLR<2.605 group had superior disease control rate(82.9%vs 26.3%,P<0.05).Patients with an 30%increase in NLR were associated with lower DCR compared with those with stable or decrease in NLR after two cycles.Conclusion:NLR is one of the biological makers indicating the prognosis of non-small cell lung cancer.Baseline NLR and NLR kinetics could be used as predictive marker for treatment with immunotherapy.