摘要
目的探讨血清细胞因子及C反应蛋白与白蛋白比值(CAR)、中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞(PLR)比值与肺癌患者免疫检查点抑制剂(ICIs)相关肺炎(ICIaP)及患者预后的关系。方法收集2018年10月至2021年12月接受至少一次ICIs治疗的无法切除的Ⅲ或Ⅳ期肺癌患者,77例患者发生ICIaP(ICIaP组),选择77例无ICIaP患者作为对照组。在基线(ICIs之前)、ICIaP诊断时(ICIaP组)和最后一次ICIs之后(对照组)收集细胞因子、血常规、CRP和ALB。比较两组基线值和各种血液参数随时间的变化。收集随访数据,并绘制生存曲线。结果Logistic回归分析显示组织学类型和ICI单药治疗是影响ICIaP的独立因素。在ICIaP组中,ICIaP确诊时血清白细胞介素(IL)-6、IL-17A、NLR、PLR、CAR较基线显著增加(P<0.05)。对照组血清IL-6和IL-17A水平随着时间的推移而降低(P<0.05),其他指标未见显著变化。ICIaP确诊时更高的IL-6、IL-17A、PLR、NLR、CAR都可以良好地预测严重ICIaP(≥3级),曲线下面积为0.712~0.859。ICIaP确诊时测得的高IL-6水平(HR=1.002,P=0.044)和高CAR(HR=1.174,P=0.049)与ICIaP不良生存有关。结论血清IL-6、IL-17A、NLR、PLR、CAR可能作为ICIaP早期诊断的生物标志物,并有助于改善ICIaP的风险分层;尤其是ICIaP症状最初发作时,高IL-6和CAR可能预示着肺癌患者预后不良。
Objective To investigate the relationship between serum cytokine and C-reactive protein to albumin ratio(CAR),neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR),immune checkpoint inhibitor(ICIs)associated pneumonia(ICIaP)and prognosis in lung cancer patients.Methods Collect unresectable stageⅢorⅣlung cancer patients who received at least one ICIs treatment from October 2018 to December 2021.Seventy-seven patients developed ICIaP(ICIaP group),and 77 patients without ICIaP were selected as the control group.Cytokines,blood routine,CRP,and ALB at baseline(before ICIs),during ICIaP diagnosis(in the ICIaP group),and after the last ICIs(in the control group)were collected.The changes in baseline values and various blood parameters over time between two groups were compared.Follow-up data was collected and survival curves were drew.Results Logistic regression analysis showed that histological type and ICI monotherapy were independent factors affecting ICIaP.In the ICIaP group,serum interleukin(IL)-6,IL-17A,NLR,PLR,and CAR significantly increased compared to baseline at the time of diagnosis of ICIaP(P<0.05).The serum levels of IL-6 and IL-17A in the control group decreased over time(P<0.05),and no significant changes were observed in other indicators.When diagnosed with ICIaP,higher levels of IL-6,IL-17A,PLR,NLR,and CAR can effectively predict severe ICIaP(≥grade 3),with an area under the curve ranging from 0.712 to 0.859.The high IL-6 levels(HR=1.002,P=0.044)and high CAR(HR=1.174,P=0.049)measured at the time of diagnosis of ICIaP are associated with poor survival in ICIaP.Conclusion Serum IL-6,IL-17A,NLR,PLR,and CAR may serve as biomarkers for the early diagnosis of ICIaP and contribute to improving the risk stratification of ICIaP.Especially during the initial onset of ICIaP symptoms,high levels of IL-6 and CAR may indicate poor prognosis in lung cancer patients.
作者
陈慧娟
张迎
黄静
谭德伦
徐瀚峰
CHEN Huijuan;ZHANG Ying;HUANG Jing;TAN Delun;XV Hanfeng(Department of Oncology,Nanjing Hospital Affiliated to Nanjing University of Traditional Chinese Medicine(Nanjing Second Hospital),Nanjing 210003,China)
出处
《临床肿瘤学杂志》
2023年第10期929-934,共6页
Chinese Clinical Oncology
关键词
肺癌
免疫检查点抑制剂
免疫检查点抑制剂相关肺炎
预后
血清细胞因子
Lung cancer
Immune checkpoint inhibitors
Immune checkpoint inhibitor associated pneumonia
Prognosis
Serum cytokines
