晚期非小细胞肺癌患者免疫治疗的预后相关因素分析

Prognostic factors of immunotherapy in patients with advanced non-small-cell lung cancer

目的探讨影响接受免疫治疗的晚期非小细胞肺癌(non-small-cell lung cancer,NSCLC)患者预后的相关因素,为临床治疗提供参考。方法回顾性分析2019年6月至2020年6月复旦大学华东医院收治的64例接受单药程序性死亡受体-1(programmed cell death-1,PD-1)/程序性死亡受体配体1(programmed cell death-ligand 1,PD-L1)抑制剂治疗的晚期NSCLC患者的临床资料及血液学指标。采用Cox单因素和多因素模型分析患者的预后相关因素。收集并记录免疫治疗的相关不良反应。结果所有患者的中位总生存期是10.4个月(95%CI:8.2~12.3个月)。多因素分析显示,ECOG评分、治疗线数、中性粒细胞与淋巴细胞比值(neutrophil-lymphocyte ratio,NLR)、血小板与淋巴细胞比值(platelet-lymphocyte ratio,PLR)、C反应蛋白和乳酸脱氢酶是影响患者无进展生存期的独立危险因素(均P<0.05)。ECOG评分、治疗线数、NLR、PLR和C反应蛋白是影响患者总生存期的独立危险因素(均P<0.05)。患者免疫治疗后不良反应发生率为48.4%(31/64),其中多数(43.8%,28/64)为1~2级,对症治疗后可好转。结论免疫治疗前NLR、PLR、C反应蛋白、ECOG评分和治疗线数与晚期NSCLC患者免疫治疗预后密切相关。NSCLC患者免疫治疗的不良反应发生率较高,但是相对安全。

Objective To investigate the prognostic factors of immunotherapy in patients with advanced non-small-cell lung cancer(NS-CLC),and to provide reference for clinical treatment.Methods Sixty-four advanced NSCLC patients treated with programmed cell death-1(PD-1)/programmed cell death-ligand 1(PD-L1)inhibitors in Huadong Hospital Affiliated to Fudan University from June 2019 to June 2020 were selected.Clinical data and serum laboratory test results were retrospectively analyzed.Cox univariate and multivariate models were used to analyze prognostic factors related to immunotherapy.The incidence of immune-related adverse events were collected.Results The median overall survival time of all patients was 10.4 months(95%CI:8.2-12.3 months).Multivariate analysis showed that ECOG score,treatment line number,neutrophil-lymphocyte ratio(NLR),platelet-lymphocyte ratio(PLR),C-reaction protein,and lactate dehydrogenase(LDH)were all independent risk factors for progression-free survival(all P<0.05).ECOG score,treatment line number,NLR,PLR,and C-reaction protein were all independent risk factors affecting overall survival(all P<0.05).The incidence of immune-related adverse events was 48.4%(31/64),and most of them(43.8%,28/64)were grade 1-2,which could be improved after supportive therapy.Conclusions ECOG score,treatment line number,NLR,PLR,and C-reaction protein are closely related to the prognosis of immunotherapy in advanced NSCLC patients.Advanced NSCLC patients have a high incidence of immune-related adverse events,but immunotherapy is relatively safe.