Clinical Value Of Eosinophils And T Lymphocyte Subsets In Immunotherapy Of Advanced Non-small Cell Lung Cancer

Objective:ICIs is a newly discovered tumor therapy in recent years,which has a promising prospect and provides a new method for the treatment of NSCLC.However,the efficacy and prognosis of NSCLC patients receiving ICIs are also different,so it is of great importance to find peripheral blood biomarkers that can predict the efficacy of tumor immunotherapy.By monitoring the changes of peripheral blood eosinophils and T lymphocyte subsets in patients with advanced NSCLC before and after receiving immunotherapy,this study analyzed the possibility of eosinophils and T lymphocyte subsets in predicting the efficacy and prognosis of immunotherapy in NSCLC,and explored the correlation between eosinophils and lymphocyte subsets in ICIs treatment.Methods:The clinical data of 88 patients with non-small cell lung cancer who received ICIs treatment in the Department of Oncology of the First Hospital of Shanxi Medical University from January 1,2019 to December 31,2021 were retrospectively analyzed.Patients’ gender,age,smoking status,pathological type,stage,distant metastasis and treatment plan were retrospectively collected.Peripheral blood eosinophils and T lymphocyte subsets including CD4+T cells,CD8+T cells,and CD4+/CD8+ were collected by flow cytometry from patients with non-small cell lung cancer before the first immunotherapy and before each immunotherapy.Statistical software SPSS22.0 was used for analysis.Quantitative data were expressed as mean ± standard deviation(X ±S).Comparison between two groups was performed by t test,and comparison within groups was performed by repeated measure design analysis of variance.Qualitative data were represented by the number of cases(%),and2ctest was used for comparison between groups.The study of prognostic factors was analyzed by Logistic regression,and the model was established by step-up regression.The inclusion criterion was 0.05,and the exclusion criterion was 0.10.Receiver operating curve(ROC curve)and Yoden index(Yoden index = sensitivity + specificity-1)were used to determine the optimal cut-off value of each index.Unifactorial analysis of survival analysis was performed by Kaplan-Meier method,and Log Rank test was used to compare the PFS differences among different eosinophils and T lymphocyte subgroups.Cox proportional hazard regression model was used to analyze the independent predictors of PFS when adjusting for other variables.In statistical analysis,P < 0.05 was considered to be statistically significant.Results:1.After 4 cycles of immunotherapy,66 patients were included in the immunotherapy effective group and 22 patients were included in the immunotherapy ineffective group.The proportion of CD4+T cells and CD4+/CD8+ in the effective immunotherapy group increased significantly after 4 cycles of treatment,and the differences were statistically significant(P<0.05),the absolute value of eosinophils and the proportion of CD8+T cells decreased significantly compared with before treatment,and the difference was statistically significant(P<0.05).There were no significant changes in the absolute value of eosinophils,the proportion of CD4+T cells,the proportion of CD8+T cells,and CD4+/CD8+ before and after immunotherapy in the ineffective group(P>0.05);2.The median PFS of 88 patients was 9 months.In all patients,the absolute count AEC(≥142.5/μL)of peripheral eosinophils before first immunotherapy was an independent predictor of longer PFS,and CD4+T cells were independent predictors of longer PFS.3.The absolute value of eosinophil and CD4+T cell ratio before initial immunotherapy were independent predictors of immunotherapy efficacy.Conclusion:1.Among all NSCLC patients treated with ICIs,patients with high baseline peripheral blood eosinophils absolute value and high CD4+T cell ratio before first immunotherapy had longer PFS and better prognosis.2.After ICIs treatment,the proportion of CD4+T cells and CD4+/CD8+ in T lymphocyte subsets of patients with effective treatment increased significantly before treatment,while the absolute value of eosinophils and the proportion of CD8+T cells decreased significantly before treatment,indicating that immunotherapy improved the immune state of the body.