老年晚期非小细胞肺癌患者PD⁃1抑制剂临床疗效及预后与淋巴细胞亚群水平的关系研究

Study on the relationship between clinical efficacy and prognostic effect of PD⁃1 inhibitors and lymphocyte subpopulation levels in elderly patients with advanced NSCLC

目的探讨老年晚期非小细胞肺癌患者淋巴细胞亚群水平与程序性细胞死亡蛋白⁃1(PD⁃1)抑制剂临床疗效及预后的关系。方法选取2021年6月至2023年4月在建湖县人民医院接受PD⁃1抑制剂治疗的非小细胞肺癌老年患者75例,根据治疗3个月后是否有效分为有效组(n=60)和无效组(n=15);根据无进展生存期(PFS,中位PFS为9个月)分为生存期长组(n=50,>9个月)和生存期短组(n=25,<9个月)。比较不同疗效组、不同预后组的临床相关指标,运用多因素Logistic回归分析预测非小细胞肺癌淋巴细胞亚群水平与PD⁃1抑制剂临床疗效及预后的独立危险因素。结果有效组的PD⁃L1≥50%占比、CD4^(+)、NK细胞和Tregs含量为51.67%、(35.08±9.45)、(21.79±9.15)、(6.61±2.53),均高于无效组的20.00%、(30.45±8.15)、(17.78±7.56)、(5.18±1.06)(P<0.05)。生存期长组的PD⁃L1≥50%占比、CD4^(+)、NK细胞和Tregs含量为60.00%、(42.65±9.85)、(23.68±9.86)、(7.65±2.51),均高于生存期短组的16.00%、(30.45±8.62)、(18.42±8.96)、(5.23±2.53)(P<0.05)。多因素Logistic回归分析结果显示,PD⁃L1、CD4^(+)、NK细胞和Tregs含量是预测非小细胞肺癌PD⁃1抑制剂临床疗效及预后的独立危险因素(OR=3.540、0.443、0.474、0.491,P<0.05)。结论通过分析老年非小细胞肺癌患者的淋巴细胞亚群水平,可以指导PD⁃1抑制剂疗效的判断,PD⁃L1、CD4^(+)、NK细胞和Tregs含量是预测非小细胞肺癌PD⁃1抑制剂临床疗效及预后的独立危险因素。

Objective To investigate the relationship between lymphocyte subpopulation levels and the clinical efficacy and prognosis of PD⁃1 inhibitors in elderly patients with advanced non⁃small cell lung cancer.Methods Seventy⁃five elderly patients with non⁃small cell lung cancer treated with PD⁃1 inhibitors in Jianhu People’s Hospital from June 2021 to April 2023 were selected,and these 75 patients were divided into an effective group(n=60)and an ineffective group(n=15)according to whether PD⁃1 inhibitors were effective after 3 month of treatment.The long survival group(n=50,>9 months)and the short survival group(n=25,<9 months)were categorized according to progression⁃free survival(PFS,Median progression⁃free survival of 9 months).The clinical correlation of different efficacy groups and different prognosis groups were compared.Multi⁃factor Logistic regression analysis was used to predict the independent risk factors between the level of lymphocyte subpopulations in non⁃small cell lung cancer and the clinical efficacy and prognosis of PD⁃1 inhibitors.Results The PD⁃L1≥50%percentage,CD4^(+),NK cells and Tregs content were 51.67%,(35.08±9.45),(21.79±9.15)and(6.61±2.53)higher in the effective group than in the ineffective group 20.00%,(30.45±8.15),(17.78±7.56)and(5.18±1.06)(P<0.05).The percentage of PD⁃L1≥50%,CD4^(+),NK cells and Tregs in the long survival group was 60.00%,(42.65±9.85),(23.68±9.86),(7.65±2.51)than in the short survival group 16.00%,(30.45±8.62),(18.42±8.96),(5.23±2.53)(P<0.05).Multi⁃factor Logistic regression analysis showed that PD⁃L1,CD4^(+),NK cells and Tregs content were independent risk factors predicting clinical efficacy and prognosis of PD⁃1 inhibitors in non⁃small cell lung cancer(OR=3.540,0.443,0.474,0.491,P<0.05).Conclusions By analyzing the lymphocyte subpopulation levels in elderly non⁃small cell lung cancer patients,it can guide the evaluation of the efficacy of PD⁃1 inhibitors.The levels of PD⁃L1,CD4^(+),NK cells,and Tregs are independent risk factors for predicting the clinical efficacy and prognosis of PD⁃1 inhibitors in non⁃small cell lung cancer.