| Objective:To analyze the relationship between the number and dynamic changes of circulating tumor cells(CTCs)in the peripheral blood of patients with advanced lung squamous cell carcinoma(LUSC)and the clinical characteristics,the efficacy and prognosis of immunotherapy combined with chemotherapy,and further explore the relationship between the level and dynamic changes of PD-L1 expression in circulating tumor cells(CTC-PD-L1)and the efficacy and prognosis of immunotherapy combined with chemotherapy.Methods:A total of thirty-nine patients with advanced LUSC who were first diagnosed in the Department of Respiratory and Critical Care Medicine of Subei People’s Hospital of Jiangsu Province from October 2018 to February 2020 and received peripheral blood CTCs detection were enrolled in this study,fifteen of whom were treated with the PD-1 inhibitor camrelizumab combined with carboplatin and paclitaxel,and twenty-four of whom were treated with placebo combined with carboplatin and paclitaxel.Venous blood of the patients was collected before treatment and on the day after two courses of treatment,respectively.The number of CTCs was detected by immunomagnetic beadsand immunofluorescence staining.Thirty-nine patients with advanced LUSC were subjected to imaging examinations every two courses of treatment and the clinical efficacy was evaluated.Analyze the relationship between the number of CTCs and clinical characteristics,the relationship between the dynamic changes of the number of CTCs and the efficacy and prognosis of immunotherapy combined with chemotherapy,and the relationship between the level and dynamic changes of CTC-PD-L1 and the efficacy and prognosis of immunotherapy combined with chemotherapy.Results:1.The number of baseline CTCs of advanced LUSC patients had no significant difference with different age range,gender,smoking history,TNM stage,distant metastasis before treatment and ECOG score(P>0.05),but had significant difference with the maximum tumor diameter(P=0.001),and the larger the maximum tumor diameter,the greater the value of baseline CTCs.2.The number of CTCs before and after treatment was significantly negatively correlated with the efficacy of the PD-1 inhibitor camrelizumab combined with carboplatin and paclitaxel(r=-0.533,P=0.041),but there was no correlation with the efficacy of placebo combined with carboplatin and paclitaxel(r=0.288,P=0.172).3.Fisher’s exact test was used to evaluate the two efficacy evaluation criteria of CTCs and RECIST,and the difference was not statistically significant(P=1.00).4.In thirty-nine patients with advanced LUSC,the median PFS of patients with CTCs number<5/6ml of peripheral blood at baseline was 34.92 weeks(95%CI:28.45-41.39 weeks),and the median PFS of patients with CTCs number≥5/6ml of peripheral blood at baseline was 22.37weeks(95%CI:17.85-26.88 weeks),and the Log-Rank test showed the difference was statistically significant(χ2=7.730,P=0.005).After two courses of treatment,the median PFS of patients with CTCs number<5/6ml of peripheral blood was 33.42 weeks(95%CI:24.39-42.45 weeks),and the median PFS of patients with CTCs number≥5/6ml of peripheral blood was 22.80 weeks(95%CI:13.23-32.37 weeks),and the Log-Rank test showed the difference was statistically significant(χ2=6.775,P=0.009).5.The median PFS of fifteen patients with advanced LUSC treated with PD-1 inhibitor camrelizumab combined with carboplatin and paclitaxel was 33.65 weeks(95%CI:28.13-39.18 weeks),and the median PFS of twenty-four patients with advanced LUSC treated with placebo combined with carboplatin and paclitaxel was 21.11 weeks(95%CI:16.86-25.37 weeks),and the Log-Rank test showed that the difference was statistically significant(χ2=11.954,P=0.001).6.The number of CTCs at baseline and different treatment methods were independent factors affecting the PFS of patients with advanced LUSC(HR=6.499,95%CI:1.016-34.103,P=0.048;HR=0.282,95%CI:0.066-0.743,P=0.037).7.The level of CTC-PD-L1 before treatment was not associated with PFS in fifteen patients with advanced LUSC treated with the PD-1 inhibitor camrelizumab combined with carboplatin and paclitaxel(P=0.960).After two courses of treatment,there was a significant negative correlation between the positive number of CTC-PD-L1 and the efficacy of camrelizumab combined with carboplatin and paclitaxel(r=-0.829,P=0.000).Conclusion:1.The detection of CTCs in peripheral blood may have a certain predictive value in the evaluation of the efficacy and prognosis of immunotherapy combined with chemotherapy in patients with advanced LUSC.The efficacy evaluation criteria of CTCs may become one of the clinical efficacy evaluation criteria.2.The level and dynamic changes of CTC-PD-L1 may have a certain predictive value for the efficacy and prognosis of immunotherapy combined with chemotherapy in patients with advanced LUSC. |
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