| Objective:Based on the retrospective analysis of 107 patients with extensive stage-small cell lung cancer(ES-SCLC)admitted to the First Hospital of Jilin University from January 2020 to February 2023,to investigate the clinical efficacy of PD-1/PD-L1 inhibitors combined with chemotherapy versus chemotherapy alone in the first-line treatment of ES-SCLC patients in the real world.For 46 patients with ES-SCLC treated with PD-1/PD-L1 inhibitors combined with first-line chemotherapy,neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR),and the significance of lymphocyte subsets to their prognosis.Methods:This study is a retrospective analysis,including 46 cases of ES-SCLC patients receiving first-line PD-1/PD-L1 inhibitors combined with chemotherapy and 61 cases of patients receiving chemotherapy alone in the First Hospital of Jilin University from January 2020 to February 2023.progression free survival(PFS)and overall survival(OS)were recorded.In addition,prognostic factors were explored in the included group of patients receiving PD-1/PD-L1 inhibitors combined with chemotherapy.Basic clinical data such as age of diagnosis,blood routine,lymphocyte subsets,NSE and serum sodium ions were collected before initial treatment,and the diagnosis and treatment process of patients was followed up,and patients’ PFS and OS were recorded.SPSS 26.0 statistical software was used for data analysis.The optimal critical values of NLR,PLR,CD3+,CD16+CD56+,CD19+ and CD4+/CD8+ were determined by the receiver operating curve(ROC).Classification data were expressed as percentage(%),and Chi-square test or Fisher exact test were used for comparison between groups.The Cox proportional hazard model was used to analyze the prognosis of ES-SCLC patients.Kaplan-Meier survival curve and Log-rank test were used for survival analysis.Results:1.The median PFS of ES-SCLC patients treated with first-line PD-1/PD-L1 inhibitors combined with chemotherapy were 9.8 months and 7.3 months(P=0.015),respectively,and the 6-month PFS rates were 80.1% and 67.2%,respectively.The median OS of the two groups was 18.8 months and 14.9 months,respectively(P=0.033).There was no significant difference in the overall incidence of adverse events between the two groups(P=0.729).2.Among the included 46 patients treated with first-line PD-1/PD-L1 inhibitors combined with chemotherapy for ES-SCLC,univariate analysis showed that PFS of thoracic radiation therapy(P=0.005),low NLR group(P<0.001),low PLR group(P=0.012),and high CD4+/CD8+ group(P=0.011)were longer than those of no thoracic radiation therapy,high NLR group,high PLR group,and low CD4+/CD8+group.Patients with low NLR(P=0.003),high CD4+/CD8+(P=0.001),no multiple organ metastases(P=0.010),and age ≤60 years old(P=0.043)had longer OS.3.Multivariate analysis showed that PLR(P=0.019),CD4+/CD8+(P=0.026)and thoracic radiation therapy(P=0.003)were independent prognostic factors for PFS in patients with ES-SCLC treated with PD-1/PD-L1 inhibitors combined with chemotherapy.NLR(P<0.001)and CD4+/CD8+(P<0.001)were independent prognostic factors for OS.Conclusions:1.The clinical efficacy of PD-1/PD-L1 inhibitors combined with chemotherapy in first-line treatment of ES-SCLC was better than that of chemotherapy alone,and it was safe and tolerable.2.High NLR at initial treatment was associated with the progress of patients receiving PD-1/PD-L1 inhibitor combined with first-line chemotherapy for ES-SCLC,but was not an independent prognostic factor.3.High PLR(> 122.03),low CD4+/CD8+(≤1.43)and no thoracic radiation therapy were correlated with the progression of patients with ES-SCLC treated with PD-1/PD-L1 inhibitors combined with chemotherapy,and were independent risk factors for PFS.4.Low NLR(≤2.45)and high CD4+/CD8+(>1.43)were independent prognostic factors for OS in patients receiving PD-1/PD-L1 inhibitors combined with first-line chemotherapy for ES-SCLC. |
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