晚期非小细胞肺癌免疫治疗疗效及其影响因素研究

Study on efficacy of immunotherapy on advanced non-small cell lung cancer and its influencing factors

目的通过分析不同细胞程序性死亡受体配体1(PD-L1)表达水平晚期非小细胞肺癌患者的免疫治疗疗效,探讨其可能的影响因素。方法43例晚期非小细胞肺癌患者,根据PD-L1表达水平不同分为阴性组(18例)、1%~49%组(13例)、≥50%组(12例)。三组患者均行免疫治疗。比较三组患者的临床资料;统计患者的总生存期(OS)、无进展生存期(PFS);分析患者免疫治疗疗效的影响因素。结果三组患者的年龄、性别、体力活动状态(PS)评分、分期、脑转移、肾上腺转移、其他位置转移、病理类型比较差异无统计学意义(P>0.05);阴性组有吸烟史17例(94.44%),1%~49%组12例(92.31%),≥50%组5例(41.67%);阴性组驱动基因突变1例(5.56%),1%~49%组5例(38.46%),≥50%组0例(0);阴性组骨转移6例(33.33%),1%~49%组0例(0),≥50%组5例(41.67%)。三组患者的吸烟史、驱动基因突变、骨转移情况比较差异具有统计学意义(P<0.05)。在OS方面,单因素分析显示:PD-L1表达水平、年龄、驱动基因突变以及分期和患者的OS有关(P<0.05);多因素分析显示:PD-L1表达水平、年龄、驱动基因突变以及分期是患者OS的独立影响因素(P<0.05)。在PFS方面,单因素分析显示,PD-L1表达水平、年龄、驱动基因突变和患者的PFS有关(P<0.05);多因素分析显示:PD-L1表达水平、年龄是患者PFS的独立影响因素(P<0.05)。结论晚期非小细胞肺癌PD-L1表达水平与患者预后相关,PD-L1表达水平、年龄是影响患者PFS的独立影响因素,而PD-L1表达水平、年龄、驱动基因突变以及分期是影响患者OS的独立影响因素。

Objective To discuss the possible factors influencing the efficacy of immunotherapy by analyzing the immunotherapeutic efficacy of advanced non-small cell lung cancer patients with different expression of programmed death-1(PD-L1).Methods 43 patients with advanced non-small cell lung cancer were divided into negative group(18 cases),1%-49%group(13 cases),and≥50%group(12 cases)according to different expression levels of PD-L1.All patients in three groups received immunotherapy.The clinical data of the three groups were compared.The overall survival(OS)and progression-free survival(PFS)were counted.The factors influencing the efficacy of immunotherapy were analyzed.Results There was no statistically significant difference in age,gender,physical status(PS)score,stage,brain metastasis,adrenal metastasis,other location metastasis and pathological type among the three groups(P>0.05).History of smoking was found in 17 cases(94.44%)in the negative group,12 cases(92.31%)in the 1%-49%group,and 5 cases(41.67%)in the≥50%group;driver gene mutation was found in 1 case(5.56%)in the negative group,5 cases(38.46%)in the 1%-49%group,and 0 case(0)in the≥50%group;bone metastases were found in 6 cases(33.33%)in the negative group,0 cases(0)in the 1%-49%group,and 5 cases(41.67%)in the≥50%group.There were statistically significant differences in smoking history,driver gene mutation and bone metastasis among the three groups(P<0.05).In terms of OS,univariate analysis showed that the expression level of PD-L1,age,driver gene mutation and stage were related to OS(P<0.05).Multivariate analysis showed that PD-L1 expression level,age,driver gene mutation and stage were independent influencing factors of OS(P<0.05).In terms of PFS,univariate analysis showed that the expression level of PD-L1,age,and driver gene mutation were related to PFS(P<0.05).Multivariate analysis showed that the expression level of PD-L1 and age were independent influencing factors of PFS(P<0.05).Conclusion The expression level of PD-L1 in advanced non-small cell lung cancer is related to the prognosis of patients.The expression level of PD-L1 and age are independent influencing factors of PFS,while the expression level of PD-L1,age,driver gene mutation and stage are independent influencing factors of OS.