晚期非小细胞肺癌合并慢性阻塞性肺疾病患者Th1/Th2及Th17/Treg与PD-1抑制剂治疗效果的关系

Correlation of Th1/Th2 and Th17/Treg with treatment efficacy of PD-1 inhibitor in advanced non-small cell lung cancer patients complicated with chronic obstructive pulmonary disease

目的探讨晚期非小细胞肺癌(NSCLC)合并慢性阻塞性肺疾病(COPD)患者外周血辅助性T细胞1/辅助性T细胞2(Th1/Th2)、辅助性T细胞17/调节性T细胞(Th17/Treg)与程序性死亡受体1(PD-1)抑制剂疗效的关系。方法回顾性分析苏州大学附属苏州九院2021年4月至2022年9月收治的107例晚期NSCLC合并COPD患者的临床资料。患者均接受PD-1抑制剂治疗,根据临床疗效将患者分为疾病控制组(82例)和疾病进展组(25例)。对比两组患者治疗前Th1/Th2、Th17/Treg及临床资料,采用logistic回归分析患者PD-1抑制剂疗效的影响独立因素。结果治疗前疾病控制组Th1/Th2、Th17/Treg均高于疾病进展组(12.49±1.14比7.04±1.06,t=21.26,P<0.001;0.14±0.03比0.09±0.04,t=6.72,P<0.001)。与疾病控制组相比,疾病进展组TNM分期Ⅳ期、存在淋巴结转移和脑转移患者比例均更高(均P<0.01)。多因素logistic回归分析结果显示,治疗前Th1/Th2(OR=0.744,95%CI 0.685~0.799,P<0.001)、治疗前Th17/Treg(OR=0.514,95%CI 0.465~0.552,P<0.001)、TNM分期(OR=1.258,95%CI 1.049~1.656,P=0.048)、淋巴结转移情况(OR=1.790,95%CI 1.223~2.734,P=0.005)及脑转移情况(OR=1.640,95%CI 1.184~2.348,P=0.005)是晚期NSCLC合并COPD患者PD-1抑制剂疗效的独立影响因素。结论治疗前高Th1/Th2、Th17/Treg的晚期NSCLC合并COPD患者接受PD-1抑制剂治疗的效果较好。

ObjectiveTo investigate the relationship between peripheral blood helper T cell 1/helper T cell 2(Th1/Th2),helper T cell 17/regulatory T cell(Th17/Treg)and efficacy of programmed death receptor 1(PD-1)inhibitor in patients with advanced non-small cell lung cancer(NSCLC)combined with chronic obstructive pulmonary disease(COPD).MethodsThe clinical data of 107 patients with advanced NSCLC combined with COPD who were admitted to Suzhou Ninth Hospital Affiliated to Soochow University from April 2021 to September 2022 were retrospectively analyzed.The patients were treated with PD-1 inhibitor,and they were categorized into the disease control group(82 cases)and the disease progression group(25 cases)according to the clinical efficacy.Th1/Th2,Th17/Treg and clinical data of patients before treatment were compared between the two groups,and logistic regression was used to analyze the independent influencing factors of patients'PD-1 inhibitor efficacy.ResultsTh1/Th2 and Th17/Treg before treatment in the disease control group were higher than those in the disease progression group(12.49±1.14 vs.7.04±1.06,t=21.26,P<0.001;0.14±0.03 vs.0.09±0.04,t=6.72,P<0.001).The proportions of patients with TNM stageⅣ,lymph node metastasis and brain metastasis in the disease progression group were higher than those in the disease control group(all P<0.01).The results of multivariate logistic regression analysis showed that pre-treatment Th1/Th2(OR=0.744,95%CI 0.685-0.799,P<0.001),pre-treatment Th17/Treg(OR=0.514,95%CI 0.465-0.552,P<0.001),TNM stage(OR=1.258,95%CI 1.049-1.656,P=0.048),lymph node metastasis(OR=1.790,95%CI 1.223-2.734,P=0.005),and brain metastasis(OR=1.640,95%CI 1.184-2.348,P=0.005)were independent influencing factors of PD-1 inhibitor efficacy in patients with advanced NSCLC combined with COPD.ConclusionsPatients with advanced NSCLC combined with COPD who have high Th1/Th2 and Th17/Treg before treatment have good outcomes with PD-1 inhibitor therapy.