摘要
目的 探讨血清程序性细胞死亡受体1(PD-1)、程序性细胞死亡配体1(PD-L1)在晚期NSCLC患者替雷利珠单抗联合铂类治疗前后的变化。方法 选择2022年5月—2023年7月于平煤神马医疗集团总医院就诊的50例晚期NSCLC患者作为研究对象,所有患者均接受3个周期的替雷利珠单抗联合铂类治疗。测定患者治疗前、治疗1个周期、治疗结束时的血清PD-1、PD-L1水平,3个治疗周期结束后评估疗效,记录患者主要一般资料,重点分析血清PD-1、PD-L1水平变化情况,及其与治疗效果的关系。结果 相较于治疗前,治疗1个周期、治疗结束时患者的血清PD-1、PD-L1均下降,治疗结束时水平相较于治疗1个周期下降(P<0.05)。50例患者经过替雷利珠单抗联合铂类治疗3个周期,有效率为42.00%(21/50)。治疗有效、无效组PD-1、PD-L1水平组间、时点、交互对比均有差异(P<0.05),组内比较:两组治疗各时点的PD-1、PD-L1水平均较治疗前下降,治疗结束时较治疗1个周期下降(P<0.05),组间比较:无效组化疗各时点的血清PD-1、PD-L1水平均高于有效组(P<0.05)。不同肿瘤分期、肿瘤分化程度患者的PD-1、PD-L1水平对比有差异(P<0.05)。建立回归分析模型结果显示,晚期NSCLC患者替雷利珠单抗联合铂类治疗效果可能与治疗前PD-1、PD-L1水平异常过表达有关(P<0.05)。交互作用分析结果显示,血清PD-1、PD-L1对晚期NSCLC患者替雷利珠单抗联合铂类治疗无效存在正向交互作用,治疗前PD-1、PD-L1均过表达导致无效风险可能是均低表达时的320倍,协同效应为二者单独存在产生效应之和的3.39倍(SI=3.39)。结论 晚期NSCLC患者血清PD-1、PD-L1水平呈过表达,随着替雷利珠单抗联合铂类治疗的开展,患者PD-1、PD-L1水平整体有所降低,但对于治疗前PD-1、PD-L1水平异常过表达的患者,可能有治疗无效风险,应引起重视。
Objective To explore the changes of serum programmed death receptor-1 (PD-1) and programmed cell death ligand 1 (PD-L1) in patients with advanced NSCLC before and after treatment with Tislelizumab combined with platinum.Methods A prospective study was conducted on 50 patients with advanced NSCLC who visited General Hospital of Pingmei Shenma Group from May 2022 to July 2023.All patients received three cycles of treatment with Tislelizumab combined with platinum therapy.The levels of serum PD-1 and PD-L1were measured before treatment,1 cycle of treatment and at the end of treatment.The efficacy was evaluated after 3treatment cycles.The main general data of the patients were recorded,and the changes of serum PD-1 and PD-L1levels and their relationship with the therapeutic effect were analyzed.Results Compared to before treatment,the serum levels of PD-1 and PD-L1 in patients decreased after one cycle of treatment.At the end of treatment,the levels decreased compared to one cycle of treatment (P<0.05).Fifty patients underwent three cycles of treatment with Tislelizumab combined with platinum,with an effective rate of 42.00%(21/50).There were significant differences in the levels of PD-1 and PD-L1 between the effective and ineffective treatment groups at different time points and interactions (P<0.05).Intragroup comparison:The levels of PD-1 and PD-L1 at each time point of treatment in both groups decreased compared to those before treatment,and decreased at the end of treatment compared to one cycle of treatment (P<0.05).Inter group comparison:The serum levels of PD-1 and PD-L1 in the ineffective group were higher than those in the effective group at all time points of chemotherapy (P<0.05).There were significant differences in the levels of PD-1 and PD-L1 among patients with different tumor stages and degrees of tumor differentiation (P<0.05).The results of established regression analysis model showed that the therapeutic effect of Tislelizumab combined with platinum therapy in advanced NSCLC patients might be related to abnormal over-expression of PD-1 and PD-L1 levels before treatment (P<0.05).The results of interaction analysis showed that serum PD-1 and PD-L1 had a positive interaction effect on the ineffectiveness of Tislelizumab combined with platinum therapy in advanced NSCLC patients.The risk of ineffectiveness caused by over-expression of PD-1 and PD-L1 before treatment might be 320 times higher than that caused by low expression,and the synergistic effect was 3.39 times of the sum of the effects produced by the two alone (SI=3.39).Conclusions The serum levels of PD-1 and PD-L1 are over-expressed in patients with advanced NSCLC.With the development of Tislelizumab combined with platinum therapy,the overall levels of PD-1 and PD-L1 in patients have decreased.However,for patients with abnormal over-expression of PD-1 and PD-L1levels before treatment,there may be a risk of ineffective treatment,which should be payed attention seriously.
作者
王进隆
刘扬帆
张茹
任中海
屈中玉
Wang Jinlong;Liu Yangfan;Zhang Ru;Ren Zhonghai;Qu Zhongyu(Department of Oncology,Nanyang Central Hospital,Nanyang,Henan 473000,China)
出处
《齐齐哈尔医学院学报》
2024年第7期622-627,共6页
Journal of Qiqihar Medical University
基金
河南省医学科技攻关计划联合共建项目(LHGJ20191450)。
