Pind模型在小细胞肺癌精准免疫治疗预后的初步研究

A preliminary study of Pind model in prediction of prognosis of patients with small cell lung carcinoma after precision immunotherapy

目的:通过分析中性粒细胞-淋巴细胞比值(neutrophil lymphocyte ratio,NLR)、血小板-淋巴细胞比值(platelet lymphocyte ratio,PLR)、乳酸脱氢酶(lactate dehydrogenase,LDH)水平,探索上述指标在评估小细胞肺癌(SCLC)肝转移免疫治疗后获益人群的价值。方法:对2021年11月—2022年8月收集的确诊为SCLC合并肝转移患者并在赣州市人民医院经过化放疗联合程序性死亡受体1(PD-1)/程序性死亡配体1(PD-L1)抑制剂治疗的56例患者的临床资料,随访截止时间为2022年9月。收集所有患者治疗前、后的血常规及LDH数值。绘制接收者操作特征(ROC)曲线,所选指标为NLR,PLR,LDH。Youden指数最大时定为NLR,PLR和LDH的最佳截断值,并分别将病例分为低指标组和高指标组,采用多因素Cox回归分析,筛选SCLC肝转移免疫治疗后生存期的独立预测标志物。结果:治疗前NLR,PLR水平与患者接受免疫治疗的客观缓解率(ORR)相关;经过对患者的无进展生存期(PFS)进行单因素分析,得出影响肝转移患者PFS的危险因素为:高NLR、高PLR及高LDH。采用Cox比例风险模型对单因素分析获取的危险因素进行分析,得出肝转移患者PFS的独立危险因素为:高NLR及高LDH。结论:NLR,PLR,LDH指标能够用于预测SCLC免疫治疗后的生存期。

Objective:To explore the value of neutrophil lymphocyte ratio(NLR),platelet lymphocyte ratio(PLR),and lactate dehydrogenase(LDH)levels in evaluating the benefits of immunotherapy for lung small cell carcinoma with liver metastasis.Methods:From November 2021 to August 2022,the clinical data of 56 patients diagnosed with pulmonary small cell lung carcinoma(SCLC)with liver metastases and treated with chemoradiotherapy combined with programmed cell death-1(PD-1)/programmed cell death-ligand 1(PD-L1)inhibitors in our hospital were collected,and the follow-up was cut in September 2022.Blood routine examinations and LDH values before and after treatment of all patients were collected.The ROC curve was plotted and the optimal cutoff values of NLR,PLR and LDH were determined when the Youden index was maximum.The cases were divided into low indicator score group and high indicator score group respectively.Multivariate Cox regression analysis was used to screen independent predictors of survival after immunotherapy for SCLC liver metastasis.Results:The levels of NLR and PLR before treatment were related to the objective response rate(ORR)of patients receiving immunotherapy.Through univariate analysis of patients'progression free survival(PFS),we concluded that the risk factors of PFS in patients with liver metastasis were high NLR,high PLR and high LDH.The Cox proportional hazards model was used to analyze the risk factors obtained from the univariate analysis.The independent risk factors of PFS in patients with liver metastasis were high NLR and high LDH.Conclusion:NLR,PLR and LDH can be used to predict the survival of SCLC after immunotherapy.