摘要
目的探讨中性粒细胞与淋巴细胞比值(NLR)、淋巴细胞与单核细胞比值(LMR)、C反应蛋白(CRP)与晚期非小细胞肺癌(NSCLC)患者免疫治疗后疗效之间的关系。方法回顾性分析安徽理工大学第一附属医院2021年12月至2023年5月收治的接受免疫治疗的NSCLC患者47例的临床资料。根据免疫治疗持续时间划分,超过1年的患者被归为免疫反应良好型,而持续时间不足1年的则为免疫反应不良型,比较免疫反应良好型和免疫反应不良型患者临床病理特征。采用受试者操作特征(ROC)曲线计算NLR、LMR、CRP等指标截断值,并根据截断值进行分组,比较不同组合间联合的预测概率。对影响患者存活的因素进行单因素和多因素Cox分析。结果免疫反应良好型与免疫反应不良型治疗线数、NLR、LMR、CRP不同水平占比差异均有统计学意义(均P<0.05)。NLR指标曲线下面积(AUC)值为0.763[95%CI:(0.608,0.918)],LMR指标AUC为0.715[95%CI:(0.544,0.875)],CRP指标AUC为0.697[95%CI:(0.540,0.853)],采用联合指标预测NSCLC免疫治疗后的诊断价值,将不同指标进行组合,得到自变量NLR+LMR、NLR+CRP、LMR+CRP、NLR+LMR+CRP。依据概率绘制ROC曲线。NLR+LMR+CRP结果显示三者联合的预测效能最好,AUC为0.897[95%CI:(0.806,0.988)]。单因素以及多因素Cox分析显示LMR[HR:0.428;95%CI:(0.213,0.858),P=0.017]和治疗线数[HR:1.815;95%CI:(1.005,3.642),P=0.033]均为无进展生存期(PFS)的重要独立预后因素。结论NLR、LMR、CRP与局部晚期NSCLC免疫治疗后的疗效存在相关性,并具有一定的预测价值。LMR和治疗线数是PFS的独立预后因素。
ObjectiveTo investigate the relationship between the neutrophil-to-lymphocyte ratio(NLR),lymphocyte-to-monocyte ratio(LMR),C-reactive protein(CRP),and the efficacy of immunotherapy in patients with advanced non-small cell lung cancer(NSCLC).MethodsThe clinical data of 47 patients with NSCLC who received immunotherapy at The First Affiliated Hospital of Anhui University of Science and Technology from December 2021 to May 2023 were retrospectively analyzed.Based on the duration of immunotherapy,patients with a duration of more than 1 year were classified as having a good immune response,while those with a duration of less than 1 year were classified as having a poor immune response.The clinical pathological characteristics of patients with good and poor immune responses were compared.The cutoff values for NLR,LMR,and CRP were calculated using receiver operating characteristic curves,and patients were grouped based on these cutoff values.The predictive probabilities of different combinations were compared.Univariate and multivariate Cox analyses were performed to identify factors affecting patient survival.ResultsSignificant differences were observed in the distribution of therapy lines(1 st-line vs.2 nd-line treatment),NLR,LMR,and CRP levels between patients with good immune response and those with poor immune responses(all P<0.05).The area under the curve(AUC)for NLR was 0.763[95%CI:(0.608,0.918)],the AUC for LMR was 0.715[95%CI:(0.544,0.875)],and the AUC for CRP was 0.697[95%CI:(0.540,0.853)].To assess the diagnostic value of combined indicators in predicting the efficacy of immunotherapy in NSCLC,different indicators were combined,resulting in the variables NLR+LMR,NLR+CRP,LMR+CRP,and NLR+LMR+CRP.Receiver Operating Characteristic curves were plotted based on the probabilities.The combination of NLR+LMR+CRP showed the best predictive performance,with an AUC of 0.897[95%CI:(0.806,0.988)].Univariate and multivariate Cox analyses indicated that LMR[HR:0.428;95%CI:(0.213,0.858),P=0.017]and the distribution of treatment lines[HR:1.815;95%CI:(1.005,3.642),P=0.033]were important independent prognostic factors for progression-free survival.ConclusionsNLR,LMR,and CRP are correlated with immunotherapy efficacy in patients with NSCLC and provide predictive value.LMR and treatment line are independent prognostic factors for progression-free survival.
作者
王琛琛
铁小伟
张延顺
张宏江
陈思梦
王勇
王成成
王浩彪
Wang Chenchen;Xiaowei Tie;Zhang Yanshun;Zhang Hongjiang;Chen Simeng;Wang Yong;Wang Chengcheng;Wang Haobiao(Department of Medical Oncology,The First Affiliated Hospital of Anhui University of Science&Technology,Huainan 232001,Anhui Province,China;School of Medicine,Anhui University of Science&Technology,Huainan 232001,Anhui Province,China)
出处
《中国基层医药》
2025年第7期963-967,共5页
Chinese Journal of Primary Medicine and Pharmacy
基金
安徽省淮南市科技计划((20210930)-Z016)
安徽理工大学医学专项培育项目(YZ2023H1C011)。
关键词
癌
非小细胞肺
预测
无病生存
粒细胞
淋巴细胞
单核细胞
C反应蛋白质
随访研究
Carcinoma,non-small-cell lung
Forecasting
Disease-free survival
Granulocytes
Lymphocytes
Monocytes
C-reactive protein
Follow-up studies
