外周血炎性指标在晚期胃癌免疫检查点抑制剂治疗效果及预后价值中的临床研究

张俏; 周学志; 程赛; 孟涛; 高正杰; 张德重; 朱绍辉

doi:10.16766/j.cnki.issn.1674-4152.003364

外周血炎性指标在晚期胃癌免疫检查点抑制剂治疗效果及预后价值中的临床研究

doi: 10.16766/j.cnki.issn.1674-4152.003364

1.
新乡医学院第一附属医院胃肠外科减重代谢与疝外科，河南新乡 453100
2.
新乡医学院医学工程学院，河南新乡 453000
3.
新乡医学院第一附属医院皮肤科

基金项目:

国家自然科学基金项目 82302298

河南省医学科技攻关计划联合共建项目 LHGJ20210523

河南省医学科技攻关计划联合共建项目 LHGJ20220597

河南省医学科技攻关计划项目 19A320003

详细信息

通讯作者:
朱绍辉，E-mail：shaohui912@126.com

中图分类号: R735.2 R730.43
计量
- 文章访问数: 48
- HTML全文浏览量: 18
- PDF下载量: 19
- 被引次数: 0
出版历程
- 收稿日期: 2023-08-12
- 网络出版日期: 2024-03-27

Clinical study on the therapeutic effect and prognostic value of peripheral blood inflammatory indexes in the treatment of advanced gastric cancer with immune checkpoint inhibitors

1.
Department of Gastrointestinal, Bariatric Metabolism and Hernia Surgery, the First Affiliated Hospital of Xinxiang Medical College, Xinxiang, Henan 453100, China

摘要

摘要: 目的探究预后营养指数(PNI)、中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)对接受免疫检查点抑制剂(ICIs)治疗的晚期胃癌(AGC)疗效及预后价值评估。方法回顾性分析新乡医学院第一附属医院2019年6月—2022年1月接受ICIs治疗75例AGC患者的临床资料。应用ROC曲线计算PNI、NLR、PLR最佳截断值。绘制Kaplan-Meier曲线并运用Cox比例风险模型预测影响AGC总生存期(OS)的独立危险因素。结果 PNI、NLR0、PLR0、PLR4的最佳截断值为36.00、3.45、186.65、138.23。高PNI组和低PLR0组客观缓解率(ORR)更高；高PNI组、低NLR0组、低PLR0组和低PLR4组疾病控制率(DCR)更高，差异均有统计学意义(P<0.05)。单因素分析显示，PNI、NLR0、PLR0、PLR4、BMI、分期均与OS相关。多因素分析显示，分期(HR=2.040，95% CI：1.120~3.730，P=0.020)及PLR0(HR=3.539，95% CI：1.717~7.296，P＜0.001)是OS的独立影响因素。结论 PNI、NLR0、PLR0、PLR4对接受ICIs治疗的AGC疗效及预后具有临床指导价值。
- 晚期胃癌 /
- 免疫检查点抑制剂 /
- 外周血炎症指标 /
- 免疫治疗 /
- 疗效 /
- 预后
Abstract: Objective To explore the efficacy and prognostic value of prognostic nutrition index (PNI), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) in advanced gastric cancer (AGC) treated with immune checkpoint inhibitors (ICIs). Methods A retrospective analysis was conducted on the clinical data of 75 AGC patients who received ICIs treatment at the First Affiliated Hospital of Xinxiang Medical College from June 2019 to January 2022. The ROC curve was used to calculate the optimal cutoff values for PNI, NLR, and PLR. Kaplan-Meier curves was plotted, and cox regression analysis was used to predict the independent risk factors affecting overall survival (OS) in AGC. Results The best cutoff values for PNI, NLR0, PLR0, and PLR4 were 36.00, 3.45, 186.65, and 138.23, respectively. The objective response rate (ORR) of high PNI group and low PLR0 group were higher. The disease control rate (DCR) of high PNI group, low NLR0 group, low PLR0 group and low PLR4 group were higher, and the differences were statistically significant (P<0.05). Univariate analysis showed that PNI, NLR0, PLR0, PLR4, BMI and stage were correlated with OS. Multivariate analysis showed that PLR0 was an independent risk factor for OS (HR=3.539, 95% CI: 1.717-7.296, P<0.001) and PFS (HR=4.556, 95% CI: 1.955-10.617, P<0.001) except stage. Conclusion Detection of PNI, NLR0, PLR0, and PLR4 has clinical guiding value for the efficacy and prognosis of AGC after ICIs treatment.
- Advanced gastric cancer /
- Immune checkpoint inhibitors /
- Peripheral blood inflammatory markers /
- Immunotherapy /
- Efficacy /
- Prognosis

HTML全文

图 1 接受ICIs治疗的AGC患者生存曲线

Figure 1. Survival curves of AGC patients treated with ICIs

下载: 全尺寸图片幻灯片

表 1 不同水平PNI、NLR0、PLR0及PLR4的AGC患者治疗后ORR和DCR比较[例(%)]

Table 1. Comparison of ORR and DCR after treatment in AGC patients with different levels of PNI, NLR0, PLR0 and PLR4 [cases (%)]

组别	例数	ORR	DCR
低PNI组(PNI≤36.00)	22	1(4.76)	5(22.73)
高PNI组(PNI＞36.00)	53	15(28.30)	49(92.45)
χ²值		3.908	37.491
P值		0.048	＜0.001
低NLR0组(NLR≤3.45)	49	13(26.53)	45(91.84)
高NLR0组(NLR＞3.45)	26	3(11.54)	9(34.62)
χ²值		2.275	27.589
P值		0.131	＜0.001
低PLR0组(PLR≤186.65)	49	15(30.61)	44(89.79)
高PLR0组(PLR＞186.65)	26	1(3.85)	9(34.62)
χ²值		7.252	24.952
P值		0.007	＜0.001
低PLR4组(PLR≤138.23)	53	13(24.53)	48(90.56)
高PLR4组(PLR＞138.23)	22	3(13.64)	6(27.27)
χ²值		0.546	30.893
P值		0.460	＜0.001

下载: 导出CSV

表 2 影响晚期胃癌患者OS的单因素和多因素分析

Table 2. Univariate and multivariate analysis of OS in patients with advanced gastric cancer

变量	单因素分析			多因素分析
变量	HR值	95% CI	P值	HR值	95% CI	P值
高PNI(参照：低PNI)	0.424	0.253~0.711	＜0.001	0.537	0.276~1.044	0.067
高NLR0(参照：低NLR0)	1.710	1.050~2.780	0.020	0.727	0.349~1.511	0.393
高PLR0(参照：低PLR0)	5.702	3.299~9.855	＜0.001	3.539	1.717~7.296	＜0.001
高PLR4(参照：低PLR4)	2.087	1.258~3.463	0.002	1.457	0.735~2.888	0.280
高BMI(参照：低BMI)	0.485	0.302~0.780	0.003	0.910	0.510~1.630	0.750
分期Ⅳ期(参照：Ⅲ期)	2.296	1.360~3.876	0.002	2.040	1.120~3.730	0.020

下载: 导出CSV

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