肺免疫预后指数与局部晚期非小细胞肺癌放化疗预后的关系

Relationship between lung immune prognostic and the prognosis of locally advanced non-small cell lung cancer treated with radiochemotherapy

目的探讨肺免疫预后指数(LIPI)与局部晚期非小细胞肺癌(LA-NSCLC)放化疗预后的关系。方法回顾性分析2013—2019年在郑州大学附属肿瘤医院行放化疗的LANSCLC患者临床资料。根据血液学衍生粒淋比(dNLR)和乳酸脱氢酶(LDH)检测结果,对患者进行LIPI评分,dNLR≤3及LDH≤正常值上限(ULN)为LIPI优组,dNLR>3或LDH>ULN为LIPI良组,dNLR>3及LDH>ULN为差组。采用Kaplan-Meier法、Log-rank法及Cox回归计算总生存(OS)及无进展生存(PFS)率。结果共入组238例患者,中位随访时间37.1个月,全组中位PFS 16.1个月,中位OS 30.6个月。LIPI差组与优组、良组相比,OS及PFS较低(χ^(2)=9.04、2.88,P<0.05)。单因素分析结果显示,影响OS的因素包括性别、病理类型、表皮生长因子受体(EGFR)突变和LIPI分组(χ^(2)=6.10、13.66、10.58、9.04,P<0.05)。仅LIPI分组是可影响PFS的因素(χ^(2)=2.88,P=0.03)。多因素分析提示,EGFR突变及LIPI各分组与患者OS具有独立相关性(HR=1.31、1.36;95%CI:1.03~1.67、1.05~1.76;P<0.05)。结论LIPI是LANSCLC放化疗的潜在预后指标,但仍需前瞻性研究进一步证实。

Objective To investigate the relationship between lung immune prognostic index(LIPI)and the prognosis of locally advanced non-small cell lung cancer(LA-NSCLC)treated with radiochemotherapy.Methods A retrospective analysis was conducted for the clinical data of LA-NSCLC patients who received radiochemotherapy in the Affiliated Cancer Hospital of Zhengzhou University from 2013 to 2019.According to the hematologic test result of the derived neutrophil-to-lymphocyte ratio(dNLR)and the lactate dehydrogenase(LDH),the patients were divided into three groups according to their LIPI scores,namely the good-LIPI group with dNLR≤3 and LDH≤upper limit of normal(ULN),moderate-LIPI group with dNLR>3 or LDH>ULN,and poor-LIPI group with dNLR>3 and LDH>ULN.Moreover,the overall survival(OS)and the progression-free survival(PFS)were calculated using the Kaplan-Meier method,the Log-rank test,and the Cox regression model.Results A total of 238 patients were enrolled,and their median follow-up time was 37.1 months,median PFS 16.1 months,and median OS 30.6 months.The OS and PFS of the poor-LIPI group were significantly worse than those of the goodand moderate-LIPI groups(χ^(2)=9.04,2.88,P<0.05).The univariate analysis showed that the factors influencing OS included gender,pathological type,epidermal growth factor receptor(EGFR)mutations,and LIPI(χ^(2)=6.10,13.66,10.58,9.04,P<0.05),and the PFS was only affected by the LIPI(χ^(2)=2.88,P=0.03).Multivariate analysis suggested that EGFR mutations and LIPI were independent prognostic markers for OS(HR=1.31,1.36;95%CI:1.03-1.67,1.05-1.76;P<0.05).Conclusions The LIPI is a potential prognostic indicator of radiochemotherapy in LA-NSCLC,and this result should be further confirmed by prospective studies.