| Objective: Immunotherapy has become another important tumor treatment after surgery,chemotherapy,radiotherapy,and targeted therapy,especially immune checkpoint inhibitors,which have been included in various treatment guidelines.However,immunotherapy is still relatively expensive,with a single drug efficiency of only 20%-40%,and is associated with a significant increase in the number of tumors due to programmed death 1(PD-L1),mismatch repair(MMR)/microsatellite instability(MSI)and tumor mutation burden(Tumor mutation burden).The population benefited from immunotherapy is still not precisely determined due to the limitation of the expression of markers such as Tumor mutation burden(TMB).Peripheral blood-associated inflammatory cells reflect the dynamic relationship between local and systemic inflammation and immune response,and have the advantages of being non-invasive,easy to calculate and inexpensive,making it a hot spot for immunotherapy biomarker research.The main objective of this study was to investigate the predictive value of peripheral blood biomarkers on the efficacy of immunotherapy in patients with advanced tumors.Methods: One hundred and eleven patients with advanced tumors who received immunotherapy in the Department of Medical Oncology of Yiji Shan Hospital from September 2020 to June 2022 were included,and their relevant serum inflammatory markers were collected,and the best cut-off values were calculated by applying the subjects’ working characteristic curves and the Jorden index and dividing the inflammatory indexes into two groups with high and low levels.Progression free survival(PFS)was calculated and compared using the Kaplan-Meier method and the log-rank test,and PFS was followed up to June 30,2022.Categorical variables were compared using chi-square test or Fisher exact test.wilcoxon rank sum test was used to compare the difference in levels of each inflammatory marker before treatment(baseline)and at the first efficacy evaluation.Univariate and multifactorial Cox regression models were used for prognostic analysis.p-values <0.05 were defined as statistically significant.Results: The optimal cut-off values for serum inflammatory markers NLR,PLR,SII,and LDH were 3.4,165,787,and 692 U/L,respectively.patients with elevated baseline NLR,PLR,SII,and LDH levels had shorter PFS associated with them(P < 0.001,P = 0.018,P= 0.016,and P = 0.249).Multifactorial analysis showed that PD-L1 expression level(P=0.032)as well as high baseline NLR level(>3.4,P=0.018)were prognostic factors for PFS.Patients’ baseline NLR,PLR,and SII levels were significantly lower compared with those at the first efficacy evaluation after 2-3 cycles of treatment(P=0.001,P<0.001,P<0.001),and patients were regrouped after 2-3 cycles of treatment to assess treatment response based on inflammatory marker levels,and all three were significantly lower in terms of objective response rate(ORR)and disease control rate(There was no significant improvement in objective response rate(ORR)and disease control rate(DCR).Conclusion: In patients with advanced tumors treated with immune checkpoint inhibitors,PD-L1 expression levels correlated with baseline NLR levels and PFS prognosis.Patients with low pre-treatment inflammatory marker levels had a better outcome,and their rising levels suggested progression.Dynamic monitoring of inflammatory markers can predict the efficacy and prognosis of anti-PD-1 therapy and help screen the best population of advanced malignancies for anti-PD-1 therapy... |
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