dNLR和LIPI对靶向药物联合免疫检查点抑制剂治疗晚期肾癌预后的影响

Prognostic Value of Derived Neutrophil-to-Lymphocyte Ratio and Lung Immune Prognostic Index in Advanced Renal Cell Carcinoma Treated with Targeted Agents Combined with Immune Checkpoint Inhibitors

目的探讨衍生的中性粒细胞淋巴细胞比值(dNLR)和肺免疫预后指数(LIPI)对靶向药物联合免疫检查点抑制剂(ICIs)治疗晚期肾癌患者预后的影响。方法回顾性收集2020年3月至2024年2月于新疆医科大学附属肿瘤医院接受靶向药物联合ICIs治疗的65例晚期肾癌患者的临床资料。根据治疗前血常规结果计算出dNLR值,采用受试者工作特征曲线(ROC)确定最佳dNLR截断值,根据截断值将患者分为低dNLR水平组(n=36)和高dNLR水平组(n=29)。根据治疗前乳酸脱氢酶(LDH)值和dNLR值算出LIPI评分,将患者分为LIPI优组(n=44)和LIPI中/差组(n=21)。使用Kaplan-Meier方法进行生存分析,并进行Log-Rank检验,采用Cox风险比例回归模型对预后影响因素进行分析。结果dNLR预测晚期肾癌患者预后的最佳截断值为2.57,曲线下面积(AUC)为0.729。低dNLR水平组患者生存率显著高于高dNLR水平组(P<0.05);LIPI优组生存率显著高于LIPI中/差组(P<0.05)。单因素生存分析结果显示,国际转移性肾细胞癌数据库联盟危险分层(IMDC)评分、体重指数(BMI)、dNLR、LDH、LIPI、淋巴结转移与患者预后均具有相关性(P<0.05)。多因素Cox生存分析结果显示,IMDC评分、dNLR、LIPI为患者预后的独立影响因素(HR>1,P<0.05)。结论dNLR水平和LIPI评分与接受靶向药物联合ICIs治疗晚期肾癌患者的预后相关,治疗前高dNLR水平及中差LIPI评分提示晚期肾癌患者的预后较差。

Objective To explore the prognostic value of the derived neutrophil-to-lymphocyte ratio(dNLR)and lung immune prognostic index(LIPI)in patients with advanced renal cell carcinoma(RCC)treated with a combination of targeted drugs and immune checkpoint inhibitors(ICIs).Methods The clinical data of 65 patients with advanced RCC who underwent treatment with targeted drugs combined with ICIs in the Affiliated Tumor Hospital of Xinjiang Medical University between March 2020 and February 2024 were retrospectively collected.The dNLR was calculated based on the results of blood routine examinations before treatment.The receiver operating characteristic(ROC)curve was employed to determine the optimal cut-off value of the dNLR,and the patients were divided into a low dNLR group(n=36)and a high dNLR group(n=29)accordingly.The LIPI was calculated based on pre-treatment lactate dehydrogenase(LDH)levels and dNLR values,and the patients were subsequently divided into a good LIPI group(n=44)and an intermediate/poor LIPI group(n=21).The Kaplan-Meier method and Log-Rank test were used for survival analysis and test.And the Cox proportional hazards regression model was used to identify prognostic factors.Results The optimal dNLR cut-off value for predicting the prognosis in advanced RCC was found to be 2.57(AUC=0.729).The survival rate in the low dNLR group was significantly higher than that in the high dNLR group(P<0.05).Meanwhile,the survival rate in the good LIPI group was significantly higher than that in the intermediate/poor LIPI group(P<0.05).Univariate analysis demonstrated that the International Metastatic RCC Database Consortium(IMDC)score,BMI,dNLR,LDH,LIPI,and lymph node metastasis were all associated with patient prognosis(P<0.05).Multivariate Cox survival analysis revealed that IMDC score,dNLR,and LIPI were independent prognostic factors for advanced RCC(HR>1,P<0.05).Conclusion The dNLR and LIPI are associated with the prognosis of patients with advanced RCC treated with a combination of targeted agents and ICIs.High dNLR and poor LIPI before treatment may indicate a intermediate/poor prognosis for patients with advanced RCC undergoing this combination treatment.