| Objective(s):To explore the correlation between the clinical characteristics of advanced NSCLC patients using PD-1 immune checkpoint inhibitors and the prognosis of immunotherapy in the real world,and to provide references for further prospective research.Methods:A retrospective data analysis of 98 patients with advanced NSCLC who were treated with immune checkpoint inhibitors at Yunnan Cancer Hospital from January 2018 to January 2021.Collect basic patient data:gender,age at the start of immunotherapy,TNM staging,pathological type,PS score,smoking history,brain metastasis status at diagnosis,liver metastasis status,primary tumor size,number of lymph node metastases,and distance The number of metastases,the immunotherapy regimen,the number of immunotherapy lines,immune-related side effects,and time to progression.Collect blood samples before the start of immunotherapy(TO)and after 2 cycles of immunotherapy(T2),including white blood cell count(WBC),absolute neutrophil count(ANC),absolute lymphocyte count(ALC),absolute monocytes Count(AMC),Absolute Eosinophil Count(AEC),Carcinoembryonic Antigen(CEA),Squamous Cell Carcinoma Antigen(SCC),Cytokeratin 19 Fragment(CYFRA21-1),and calculate the ANC/ALC ratio(NLR),ALC/AMC ratio(LMR),ANC/(WBC-ALC)ratio(dNLR).Estimate the median PFS and 95%confidence interval.The receiver operating characteristic curve(ROC)method was used to determine the best cut-off value of basic data and blood routine indexes.The cut-off value of tumor markers should refer to the upper limit of the reference value of clinical test values.Use Kaplan-Meier to perform univariate analysis and generate a survival curve,and use Cox regression risk model for multivariate analysis for univariate meaningful indicators.All statistical analysis uses SPSS version 25.0.P<0.05 was considered statistically significant.Results:The results of univariate analysis showed that the number of immunotherapy lines and liver metastasis were significantly related to disease progression.TO CYFRA21-1≥3.3ng/ml,SCC≥6μg/L,ANC≥4.89×109/L,AMC≥0.63×10^9/L,NLR>4,dNLR>1.88 and T2 CYFRA21-I≥3.3 ng/ml SCC≥6μg/L,ANC≥4.89×10^9/L,NLR≥4 can be used as negative prognostic factors for PFS.TO’s ALC≥1.44×10^9/L and T2’s LMR≥4.12 can be used as positive prognostic factors for PFS.Further multivariate analysis showed that the number of TO immunotherapy lines,SCC≥6μg/L,AMC>0.63≥10^9/L,NLR≥4,dNLR≥1.88 and T2 immunotherapy lines,CYFRA21-1≥3.3 ng/ml,ANC≥4.89×10^9/L and NLR≥4 can be used as independent negative prognostic factors for PFS.TO ALC≥1.44×10^9/L can be used as an independent positive prognostic factor for PFS.Comparing the hematological indicators after 2 cycles of treatment with baseline,univariate analysis showed that the increase of WBC and CYFRA21-1 after 2 cycles of treatment was related to poor PFS.Further multi-factor analysis showed that the increase of WBC before and after treatment can be As an independent negative prognostic factor of PFS.Safety:32 of 98 patients(32.7%)had immune-related adverse reactions.There was a significant difference in PFS between patients with immune-related adverse events and patients without immune-related adverse events(5.1 months vs 6.4 months,P=0.04).The most common immune-related adverse reactions were gastrointestinal reactions(24 cases(24.5%)),followed by bone marrow suppression(11 cases(11.2%)),pneumonia(4 cases(4.1%)),and hepatitis(2 cases(2.0%))).Conclusion(s):1.Patients with liver metastases have a higher significant risk of disease progression.2.From our results,early use of immunotherapy may result in better PFS.3.The baseline SCC value increased more than 4 times,CYFRA21-1,NLR,dNLR increased and shorter PFS.4.2 After the cycle of treatment,SCC value increased more than 4 times,CYFRA21-1,NLR increase was related to shorter PFS;LMR increase was related to longer PFS.5.Patients with adverse events in immunotherapy have shorter PFS,and more attention should be paid to the occurrence of adverse events when using immunotherapy combined with chemotherapy. |
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