目的:探讨营养指标和炎症指标预测信迪利单抗联合贝伐珠单抗治疗晚期肝细胞癌(hepatocellular carcinoma,HCC)患者预后的价值。方法:本研究为回顾性研究,选择2021年1月至2021年12月永州市中心医院收治的85例HCC患者。根据营养指标[预后...目的:探讨营养指标和炎症指标预测信迪利单抗联合贝伐珠单抗治疗晚期肝细胞癌(hepatocellular carcinoma,HCC)患者预后的价值。方法:本研究为回顾性研究,选择2021年1月至2021年12月永州市中心医院收治的85例HCC患者。根据营养指标[预后营养指数(prognostic nutritional index,PNI)和血红蛋白-白蛋白-淋巴细胞-血小板(hemoglobin-albumin-lymphocyte-platelet,HALP)评分]和炎症指标[单核细胞/高密度脂蛋白比值(monocyte to high-density lipoprotein ratio,MHR)、C反应蛋白/前白蛋白比值(C-reactive protein to prealbumin ratio,CPR)和C反应蛋白/淋巴细胞计数比值(C-reactive protein to lymphocyte ratio,CLR)]最佳临界值,将患者分为高PNI组与低PNI组、高HALP评分组与低HALP评分组、高MHR组与低MHR组、高CPR组与低CPR组及高CLR组与低CLR组。采用Kaplan-Meier法对不同营养状态或炎症水平的晚期HCC患者进行生存分析,并采用log-rank检验进行比较。采用单因素和多因素Cox回归模型筛选信迪利单抗联合贝伐珠单抗治疗后晚期HCC患者总生存期的危险因素。绘制受试者操作特征(receiver operator characteristic,ROC)曲线以评价营养指标和炎症指标对信迪利单抗联合贝伐珠单抗治疗后晚期HCC患者死亡的预测价值。结果:高PNI组、高HALP评分组、低MHR组、低CPR组、低CLR组疾病控制率(disease control ratio,DCR)均高于低PNI组、低HALP评分组、高MHR组、高CPR组、高CLR组(84.0%比65.7%,χ^(2)=19.961,P<0.001;84.8%比66.7%,χ^(2)=6.467,P=0.011;87.0%比64.1%,χ^(2)=6.127,P=0.013;92.0%比65.7%,χ^(2)=4.947,P=0.026;84.5%比63.6%,χ^(2)=4.938,P=0.016)。高PNI组、高HALP评分组、低MHR组、低CPR组、低CLR组患者总生存期均长于低PNI组、低HALP评分组、高MHR组、高CPR组、高CLR组患者(P均<0.05)。ROC曲线显示,PNI、HALP评分、MHR、CPR和CLR预测晚期HCC患者死亡的曲线下面积(area under the curve,AUC)分别为0.797[95%置信区间(95%confidence interval,95%CI):0.738~0.855]、0.773(95%CI:0.713~0.833)、0.606(95%CI:0.528~0.683)、0.726(95%CI:0.665~0.788)、0.759(95%CI:0.701~0.818)。多因素Cox回归模型分析结果表明,PNI和HALP评分是影响信迪利单抗联合贝伐珠单抗治疗后晚期HCC患者预后的独立保护因素,MHR、CPR和CLR是影响信迪利单抗联合贝伐珠单抗治疗后晚期HCC患者预后的独立危险因素。结论:营养指标和炎症指标是信迪利单抗联合贝伐珠单抗治疗晚期HCC患者预后的有效预测指标。展开更多
BACKGROUND Immune checkpoint inhibitors(ICIs)targeting the programmed death(PD)-1 pathway have substantially changed the clinical management of metastatic urothelial carcinoma(m UC);however,the response rate remains l...BACKGROUND Immune checkpoint inhibitors(ICIs)targeting the programmed death(PD)-1 pathway have substantially changed the clinical management of metastatic urothelial carcinoma(m UC);however,the response rate remains low.There are ongoing efforts to identify robust biomarkers that can effectively predict the treatment response to ICIs.Previous studies have suggested that ERBB2/3 mutations are associated with the efficacy of ICIs in gallbladder carcinoma.CASE SUMMARY We present a 59-year-old man with m UC harboring ERBB2/3 mutations(in-frame insertion of ERBB2 and ERBB3 amplification),negative PD-ligand 1 expression,and low tumor mutation burden.He received anti-PD-1 antibodies and paclitaxel as second-line treatment.After two cycles of treatment,the lung metastases had significantly shrunk,achieving good partial remission.After six cycles of combination therapy,the patient received sindilimab 200 mg once every 3 wk as maintenance monotherapy.At the last follow-up,the patient continued to exhibit a partial response and progression-free survival for as long as 19 mo.CONCLUSION ERBB2/3 mutations may represent a predictive biomarker for selecting a subgroup of m UC patients who will benefit from ICIs.展开更多
文摘目的:探讨营养指标和炎症指标预测信迪利单抗联合贝伐珠单抗治疗晚期肝细胞癌(hepatocellular carcinoma,HCC)患者预后的价值。方法:本研究为回顾性研究,选择2021年1月至2021年12月永州市中心医院收治的85例HCC患者。根据营养指标[预后营养指数(prognostic nutritional index,PNI)和血红蛋白-白蛋白-淋巴细胞-血小板(hemoglobin-albumin-lymphocyte-platelet,HALP)评分]和炎症指标[单核细胞/高密度脂蛋白比值(monocyte to high-density lipoprotein ratio,MHR)、C反应蛋白/前白蛋白比值(C-reactive protein to prealbumin ratio,CPR)和C反应蛋白/淋巴细胞计数比值(C-reactive protein to lymphocyte ratio,CLR)]最佳临界值,将患者分为高PNI组与低PNI组、高HALP评分组与低HALP评分组、高MHR组与低MHR组、高CPR组与低CPR组及高CLR组与低CLR组。采用Kaplan-Meier法对不同营养状态或炎症水平的晚期HCC患者进行生存分析,并采用log-rank检验进行比较。采用单因素和多因素Cox回归模型筛选信迪利单抗联合贝伐珠单抗治疗后晚期HCC患者总生存期的危险因素。绘制受试者操作特征(receiver operator characteristic,ROC)曲线以评价营养指标和炎症指标对信迪利单抗联合贝伐珠单抗治疗后晚期HCC患者死亡的预测价值。结果:高PNI组、高HALP评分组、低MHR组、低CPR组、低CLR组疾病控制率(disease control ratio,DCR)均高于低PNI组、低HALP评分组、高MHR组、高CPR组、高CLR组(84.0%比65.7%,χ^(2)=19.961,P<0.001;84.8%比66.7%,χ^(2)=6.467,P=0.011;87.0%比64.1%,χ^(2)=6.127,P=0.013;92.0%比65.7%,χ^(2)=4.947,P=0.026;84.5%比63.6%,χ^(2)=4.938,P=0.016)。高PNI组、高HALP评分组、低MHR组、低CPR组、低CLR组患者总生存期均长于低PNI组、低HALP评分组、高MHR组、高CPR组、高CLR组患者(P均<0.05)。ROC曲线显示,PNI、HALP评分、MHR、CPR和CLR预测晚期HCC患者死亡的曲线下面积(area under the curve,AUC)分别为0.797[95%置信区间(95%confidence interval,95%CI):0.738~0.855]、0.773(95%CI:0.713~0.833)、0.606(95%CI:0.528~0.683)、0.726(95%CI:0.665~0.788)、0.759(95%CI:0.701~0.818)。多因素Cox回归模型分析结果表明,PNI和HALP评分是影响信迪利单抗联合贝伐珠单抗治疗后晚期HCC患者预后的独立保护因素,MHR、CPR和CLR是影响信迪利单抗联合贝伐珠单抗治疗后晚期HCC患者预后的独立危险因素。结论:营养指标和炎症指标是信迪利单抗联合贝伐珠单抗治疗晚期HCC患者预后的有效预测指标。
基金Supported by the Zhejiang Medical AssociationNo. 2018ZYC-A18
文摘BACKGROUND Immune checkpoint inhibitors(ICIs)targeting the programmed death(PD)-1 pathway have substantially changed the clinical management of metastatic urothelial carcinoma(m UC);however,the response rate remains low.There are ongoing efforts to identify robust biomarkers that can effectively predict the treatment response to ICIs.Previous studies have suggested that ERBB2/3 mutations are associated with the efficacy of ICIs in gallbladder carcinoma.CASE SUMMARY We present a 59-year-old man with m UC harboring ERBB2/3 mutations(in-frame insertion of ERBB2 and ERBB3 amplification),negative PD-ligand 1 expression,and low tumor mutation burden.He received anti-PD-1 antibodies and paclitaxel as second-line treatment.After two cycles of treatment,the lung metastases had significantly shrunk,achieving good partial remission.After six cycles of combination therapy,the patient received sindilimab 200 mg once every 3 wk as maintenance monotherapy.At the last follow-up,the patient continued to exhibit a partial response and progression-free survival for as long as 19 mo.CONCLUSION ERBB2/3 mutations may represent a predictive biomarker for selecting a subgroup of m UC patients who will benefit from ICIs.
