Predict Valve Of Peripheral Blood Immune Cells Level In Immune-related Adverse Events

Study background and purpose:Immune checkpoint inhibitors(ICIs)therapy has developed rapidly in the past decade,and has now become one of the most effective means to treat tumors,and has a good development prospects.However,with the application of ICIs,it breaks the balance of immune suppression,leading to the occurrence of adverse reactions,called immune-related adverse reactions(ir AEs).The ir AEs can involve multiple organs and have complex clinical manifestations,endangering the life in severe cases.Therefore,how to predict the occurrence of ir AEs early is a clinical problem that we need to focus on studying.At present,some domestic and foreign scholars have found candidate indicators to predict the risk of ir AEs,but they still lack specificity and are difficult to be confirmed in clinical application.This study intends to explore their value in predicting the risk of ir AEs by counting the number of peripheral blood immune cells.Methods:This study collected data from 93 patients with pan-cancer solid tumors treated by ICIs at China-Japan union Hospital of Jilin University from October 1,2020 to October 1,2022,and compiled the clinical general data of the patients,such as age,gender,ethnicity,ECOG score,type of solid tumor,tumor stage,treatment plan,number of treatment lines,metastasis,type of adverse reactions and adverse reaction grade,and were retrospectively analyzed.Peripheral blood cell counts,including white blood cell count(WBC),hemoglobin(Hb),platelet count(PLT),red blood cell count(RBC),Eosinophils(EOS),lymphocytes(LYM),neutrophils(NEUT),monocyte(MONO),and ENR,NLR,and LMR were calculated.The study of the above indicators in patients with ir AEs after ICIs and control patients without ir AEs suggests the prediction of peripheral blood immune cell counts for the risk of ir AEs.Statistical analysis was performed using SPSS 26.0,data were expressed as mean ± standard deviation,data between groups were compared using a t-test for independent samples,and Logistic regression was applied to determine independent predictors.The results of each analysis were considered statistically significant at p <0.05.Results:A total of 93 patients with advanced pan-cancer species tumors treated with ICIs were collected in this study.1.Overall,the incidence of ir AEs was about 47.3%(44 out of 93),with the incidence of grade 3 and above ir AEs being 15.9%(7 / 44)and grade 2 and above being 25%(11 / 44).77.2%(34 / 44)of the patients with ir AEs developed within 2months of receiving the ICIs.2.Results from the baseline level before ICIs showed 0.01 level significance for ENR(t=-3.553,p=0.001);and 0.05 level significance for LMR(t=-2.325,p=0.022).3.Based on the level of peripheral immune cell counts 2 months after applying ICIs,ir AEs showed 0.05 significant for ENR(t=-2.117,p=0.040);ir AEs showed0.05 significant for NLR(t=-2.133,p=0.038).4.To explore the predictors of ir AEs,the study analysis showed that the regression coefficient of the baseline ENR was 27.978 and showed significance at the 0.05 level(z=2.206,p=0.027 <0.05),meaning that a higher level of ENR at baseline was significantly associated with an increased risk of ir AEs.Conclusion:1.It was found that ENR,LMR and NLR were significantly correlated with ir AEs,and detection of ENR,LMR and NLR levels before treatment could help predict the risk of ir AEs.2.ENR has a significant positive effect on ir AEs,and a higher baseline ENR level indicates a higher risk of ir AEs.