LMR、NLR与肺癌患者病理分型及免疫治疗疗效的关系研究

Correlation of LMR and NLR with pathological classification and immunotherapy efficacyin lung cancer patients

目的探讨淋巴细胞/单核细胞比值(LMR)、中性粒细胞/淋巴细胞比值(NLR)与肺癌患者病理分型及免疫治疗疗效的关系。方法收集2019年1月至2021年1月在苏州大学附属第二医院肿瘤科经病理明确且无法手术的肺癌患者为研究对象,共200例,为研究组,同期于医院进行体检的100例健康志愿者定义为对照组。比较研究组、对照组LMR、NLR。肺癌患者入院后均接受一线化疗联合分子靶向药物免疫治疗,于治疗4周期后评估免疫治疗疗效,比较疾病控制肺癌患者、疾病进展肺癌患者LMR、NLR。绘制受试者工作特征曲线(ROC)分析LMR、NLR预测肺癌患者免疫治疗疗效的最佳临界值,根据最佳临界值将200例肺癌患者分为高LMR组、低LMR组,高NLR组、低NLR组,收集肺癌患者临床资料,分析LMR、NLR与肺癌患者病理分型及免疫治疗疗效的关系。结果研究组LMR、NLR均高于对照组,组间差异有统计学意义(P<0.05)。疾病控制组肺癌患者LMR、NLR均低于疾病进展肺癌患者,差异具有统计学意义(P<0.05)。ROC曲线结果显示,LMR、NLR预测肺癌患者免疫治疗疗效的最佳截断值分别为6.27、3.86,高LMR组60例、低LMR组140例,高NLR组72例、低NLR组128例。高LMR组和低LMR组,高NLR组和低NLR组之间性别、年龄、TNM分期差异无统计学意义(P>0.05);高LMR组和低LMR组、高NLR组和低NLR组患者病理类型间差异均具有统计学意义(P<0.05);高LMR组疾病控制率(33.33%)低于低LMR组(80.00%),高NLR组疾病控制率(36.11%)低于低NLR组(82.81%),差异均具有统计学意义(P<0.05)。结论LMR、NLR与肺癌患者病理分型及免疫治疗疗效均相关,LMR、NLR低的肺癌患者中腺癌发生率最高,且LMR、NLR低的肺癌患者免疫治疗疗效较LMR、NLR高的肺癌患者免疫治疗疗效好。

Objective To investigate the correlation of lymphocyte/monocyte ratio(LMR)and neutrophil/lymphocyte ratio(NLR)with pathological classification and immunotherapy efficacy in lung cancer patients.Methods A total of 200 patients diagnosed with inoperable lung cancer in the Oncology Department of the Second Affiliated Hospital of Suzhou University from January 2019 to January 2021 were collected as the study group.And 100 healthy volunteers who underwent physical examination in the hospital during the same period were defined as the control group.The LMR and NLR of the patients in two groups were compared.All patients with lung cancer received first-line chemotherapy combined with molecular targeted drug immunotherapy after admission.The efficacy of immunotherapy was evaluated after 4 cycles of treatment.And LMR and NLR of patients with disease control lung cancer and patients with disease progression were compared.The analysis of receiver operating characteristic(ROC)curve was used to determine the optimal threshold value of LMR and NLR to predict the efficacy of immunotherapy in lung cancer patients.According to the optimal cut-off value,200 patients were divided into high LMR group,low LMR group,high NLR group and low NLR group.Clinical data of lung cancer patients were collected and the relationship between LMR,NLR,pathological classification and immunotherapy efficacy of lung cancer patients was analyzed.Results The LMR and NLR in case group were higher than those in control group significantly(P<0.05).The LMR and NLR of patients with disease control lung cancer were lower than those with disease progression,and the difference was statistically significant(P<0.05).ROC curve results showed that the optimal critical values of LMR and NLR to predict the efficacy of immunotherapy in lung cancer patients were 6.27 and 3.86,respectively,with 60 cases in the high LMR group and 140 cases in the low LMR group,72 cases in the high NLR group and 128 cases in the low NLR group.There was no significant difference in gender,age and TNM stage between high LMR group and low LMR group,and between high NLR group and low NLR group(P>0.05).There were significant differences in pathological types between high LMR group and low LMR group,as well as high NLR group and low NLR group(P<0.05).The disease control rate of the high LMR group(33.33%)was significantly lower than that of the low LMR group(80.00%).And the disease control rate of the high NLR group(36.11%)was significantly lower than that of the low NLR group(82.81%)significantly(P<0.05).Conclusions LMR and NLR are correlated with pathological classification and immunotherapy efficacy of lung cancer patients.The incidence of adenocarcinoma in lung cancer patients with low LMR and NLR is high.Moreover,the immunotherapy efficacy of lung cancer patients with low LMR and NLR is better than that of lung cancer patients with high LMR and NLR.