血管内皮生长因子与卡瑞利珠单抗治疗晚期非鳞非小细胞肺癌所致反应性毛细血管增生症的相关性

Correlation between vascular endothelial growth factor and reactive cutaneous capillary endothelial proliferation of advanced non-squamous non-small cell lung cancer patients treated with camrelizumab

目的探讨血管内皮生长因子(vascular endothelial growth factor,VEGF)对卡瑞利珠单抗(又称SHR‑1210)治疗晚期非鳞非小细胞肺癌(non‑squamous non‑small cell lung cancer,nsNSCLC)所致反应性毛细血管增生症(reactive cutaneous capillary endothelial proliferation,RCCEP)的预测作用以及两者间的相关性。方法回顾性分析我院经卡瑞利珠单抗治疗并检测VEGF的64例晚期nsNSCLC患者。将治疗后发生RCCEP的46例患者纳入A组,未发生RCCEP的18例患者纳入B组,对比两组的治疗效果及VEGF正常率,分析VEGF对RCCEP发生的预测作用,以及两者之间的相关性。结果A组和B组的客观缓解率(objective response rate,ORR)、疾病控制率(disease control rate,DCR)差异无统计学意义(P>0.05);A组VEGF高于正常值的患者明显多于B组,差异有统计学意义(P<0.001);VEGF数值预测RCCEP发生的ROC曲线下面积为0.908,预测的灵敏度为80.4%,特异度为83.3%,误诊率为16.7%,漏诊率为19.6%,约登指数为63.7%;VEGF水平和RCCEP分级之间呈正相关(r_(s)=0.806,P<0.001)。结论卡瑞利珠治疗后发生RCCEP的患者中VEGF高于正常值的发生率较多,VEGF水平对发生RCCEP有一定的预测性,其灵敏度和特异度较高,且RCCEP分级随着VEGF数值增加而升高。

Objective:To investigate the predictive effect of the vascular endothelial growth factor(VEGF)in circulating blood on reactive cutaneous capillary endothelial proliferation(RCCEP)induced by camrelizumab treatment in patients with advanced non-squamous non-small cell lung cancer.Methods:A retrospective analysis was conducted on 64 patients with advanced nsNSCLC who were treated with camrelizumab(SHR-1210)and tested for VEGF in the First Affiliated Hospital of Wannan Medical College.Forty-six patients who experienced RCCEP after treatment were divided into Group A,and 18 patients that did not experience RCCEP were divided into Group B.The treatment efficiency and the normal rate of VEGF were compared between the two groups.Moreover,the predictive effect of VEGF on the occurrence of RCCEP,and the correlation between the level of VEGF and the grade of RCCEP were analyzed.Results:Both ORR and DCR in Group A were higher than those in Group B,but the difference was not statistically significant(P>0.05).The number of patients with abnormal VEGF values in Group A was significantly larger than that in Group B(P<0.001).The AUC of the numerical prediction of VEGF for RCCEP was 0.908.The sensitivity was 80.4%,and the specificity was 83.3%.The misdiagnosis rate was 16.7%,the missed diagnosis rate was 19.6%,and the Youden index was 63.7%.VEGF level and RCCEP grade showed a positive correlation(r_(s)=0.806,P<0.001).Conclusion:The incidence of abnormal VEGF values in patients with RCCEP caused by the treatment of camrelizumab is higher.The level of VEGF has a predictive effect on the occurrence of RCCEP,and its sensitivity and specificity are high.And the RCCEP grade increases with the increase of VEGF value.