血液生物标志物与免疫治疗晚期非小细胞肺癌疗效相关性的研究

A Study on the Correlation between Blood Biomarkers and the Efficacy of Immunotherapy in Advanced Non-Small Cell Lung Cancer

摘要: 目的：探究NLR、LMR、PLR、D-D与接受免疫治疗的晚期非小细胞肺癌患者的无进展生存期的相关性。方法：回顾性分析接受免疫治疗的86例患者的临床资料，收集患者首次治疗前一周内的血常规及血清D-D，计算出NLR、LMR、PLR指标，根据RECIST1.1标准评价疗效并随访无进展生存期(progression-free survival, PFS)，使用COX比例风险回归模型进行生存分析，筛选治疗前的基线参数中与疗效相关的指标。采用Kaplan⁃Meier法绘制生存曲线，用Log⁃rank检验比较组间生存率。探讨接受免疫治疗NSCLC患者PFS的影响因素。结果：通过预测非小细胞肺癌患者死亡率的ROC曲线分析确定，NLR最佳临界值为3.985，LMR最佳临界值为2.085，PLR最佳临界值为139.5，D-D最佳临界值为0.96。经过Log-rank检验得出单因素分析结果显示：性别、基因突变状态、器官转移个数、LMR、NLR、PLR及D-D是PFS的影响因素(p < 0.05)；经过COX多元回归模型校对后，多因素分析结果显示：基因突变状态、NLR、D-D是接受免疫治疗NSCLC患者PFS的影响因素(p < 0.05)；LMR、PLR不是接受免疫治疗NSCLC患者PFS的影响因素(p > 0.05)。结论：在接受免疫治疗的NSCLC患者中，较低水平的NLR、PLR、D-D及较高水平的LMR患者与PFS更长相关，对其预后有一定的预测作用，基因突变状态、NLR、D-D是接受免疫治疗晚期NSCLC患者生存的独立预测因素。

Abstract: Objective: To explore the correlation between NLR, LMR, PLR, D-D and progression free survival in advanced non-small cell lung cancer patients receiving immunotherapy. Method: A retrospective analysis was conducted on the clinical data of 86 patients receiving immunotherapy. Blood routine and serum D-D were collected within one week before the first treatment, and NLR, LMR, and PLR indicators were calculated. The efficacy was evaluated according to the RECIST 1.1 standard and progression free survival (PFS) was followed up. The COX proportional hazards regression model was used for survival analysis, and indicators related to efficacy were screened from baseline parameters before treatment. Kaplan Meier method was used to plot survival curves, and Log rank test was used to compare survival rates between groups, exploring the influencing factors of PFS in NSCLC patients receiving immunotherapy. Result: Of ROC curve analysis for predicting the mortality rate of non-small cell lung cancer patients, the optimal critical values for NLR, LMR, PLR, and D-D were determined to be 3.985, 2.085, 139.5, and 0.96, respectively. After log rank testing, the results of univariate analysis showed that gender, gene mutation status, number of organ metastases, LMR, NLR, PLR, and D-D were the influencing factors of PFS (p < 0.05); After proofreading with Cox multiple regression model, the results of multivariate analysis showed that gene mutation status, NLR, and D-D were the influencing factors of PFS in NSCLC patients receiving immunotherapy (p < 0.05); LMR and PLR are not influencing factors of PFS in NSCLC patients receiving immunotherapy (p > 0.05). Conclusion: In NSCLC patients receiving immunotherapy, lower levels of NLR, PLR, D-D, and higher levels of LMR are associated with longer PFS and have a certain predictive effect on their prognosis. Gene mutation status, NLR, D-D are independent predictors of survival in advanced NSCLC patients receiving immunotherapy.