^(18)F-FDG PET/CT联合外周血炎症因子评估晚期非小细胞肺癌免疫治疗疗效的价值

Value of^(18)F-FDG PET/CT combined with inflammatory factors in peripheral blood in evaluating the efficacy of immunotherapy for advanced NSCLC

目的:研究^(18)F-FDG PET/CT定量参数与外周血促炎因子衍生性中性粒细胞与淋巴细胞比值(derived neutrophil-to-lymphocyte ratio,dNLR)在晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)患者免疫治疗疗效中的预后价值。方法:在这项回顾性双中心研究中,共收集了62例晚期非小细胞肺癌患者,所有患者在2018年11月至2021年10月期间至少接受4个疗程免疫联合治疗,根据RECIST 1.1标准,将患者分为疾病控制组(n=42例)和疾病进展组(n=20例)。评估基线^(18)F-FDG PET/CT代谢参数、临床特征及促炎因子dNLR在两组间的差异,多因素Logistic回归分析影响患者疾病进展的危险因素,Kaplan-Meier生存曲线比较累积生存率差异,建立无进展生存期(progression free survival,PFS)和总生存期(overall survival,OS)的Cox多变量预测模型。结果:与疾病进展组相比,疾病控制组患者的肿瘤代谢体积(metabolic tumor volume,MTV)、全身肿瘤病灶负荷(total MTV,tMTV)及dNLR值均显著降低,差异具有统计学意义(P<0.05)。多因素Logistic分析显示dNLR>3是疾病进展的独立影响因素(P<0.05)。截止随访时间,62例存活47例(75.8%)。Cox多变量回归分析显示dNLR>3和tMTV>68.5 cm^(3)是预测PFS的独立影响因素。Kaplan-Meier生存曲线显示,预后不良组患者(dNLR>3和tMTV>68.5 cm^(3))较中间预后(dNLR>3或tMTV>68.5 cm^(3))和预后良好组(dNLR≤3和tMTV≤68.5 cm^(3))患者的PFS和OS均显著降低(P<0.01)。结论:^(18)F-FDG PET/CT定量参数tMTV值结合dNLR在评估晚期非小细胞肺癌患者免疫治疗疗效方面有一定价值,联合应用可以提供不同预后分层依据。

Objective:To evaluate the prognostic value of quantitative parameters of^(18)F-fluorodeoxyglucose positron emission tomography/computed tomography(^(18)F-FDG PET/CT)combined with inflammatory factors in peripheral blood in patients with advanced non-small cell lung cancer treated with immune checkpoint inhibitors(ICIs).Methods:In this retrospective double-center research,62 patients with advanced non-small cell lung cancer were collected.All patients received at least 4 courses of immunotherapy from November 2018 to October 2021.Patients were divided into the disease control group(n=42)and the disease progression group(n=20)based on the RECIST 1.1 criteria.The differences of clinical,hematological and^(18)F-FDG PET/CT parameters between the two groups were analysed.The risk factors influencing disease progression were tested by multivariate Logistic regression.The differences in cumulative survival rates was expressed by Kaplan-Meier survival curves.A multivariate prediction models for progression-free survival(PFS)and overall survival(OS)was established by Cox model.Results:Compared with the disease progression group,MTV,tMTV and dNLR were significantly decreased in the disease control group(P<0.05).In multivariate Logistic regression analysis,dNLR>3 was an independent predictor factor of disease progression(P<0.05).The median follow-up time was 19.0 months and 47 patients survived(75.8%,47/62).Cox multivariate regression analysis showed that dNLR>3 and tMTV>68.5 cm^(3)were independent factors to predict PFS.Kaplan-Meier survival curve showed that,the PFS and OS of patients in poor prognosis group(dNLR>3 and tMTV>68.5 cm^(3))were significantly lower than that in intermediate prognosis group(dNLR>3 or tMTV>68.5 cm^(3))and good prognosis group(dNLR≤3 and tMTV≤68.5 cm^(3))(P<0.01).Conclusion:tMTV value of^(18)F-FDG PET/CT combined with dNLR has certain application value in predicting the prognosis of patients with advanced non-small cell lung cancer receiving immunotherapy.