| Objective:To evaluate the correlation between clinical immune markers and the efficacy of PD-1/PD-L1 inhibitors in the treatment of lung cancer,explore the feasibility of single or combined indicators to predict the efficacy of immunotherapy,and look for predictions that are helpful before clinical treatment..Methods:The clinical data of 200 lung cancer patients who received PD-1/PD-L1 immune checkpoint inhibitor treatment at Yunnan Cancer Hospital(the Third Affiliated Hospital of Kunming Medical University)from January 2018 to January 2021 were collected retrospectively Analyze,record the patient’s clinical data,efficacy data,survival data,and the corresponding peripheral blood index data before and after treatment.Use SPSS 25.0 statistical software for data analysis.In the efficacy analysis,single factor analysis uses test,and multivariate analysis uses logitic regression analysis.The receiver operating curve(ROC)calculates the area under the curve(AUC)of the combined index,and explores the predictive value of the combined index on the efficacy of immunotherapy.In survival analysis,Kaplan-Meier method was used for univariate analysis,and Cox proportional hazard regression model was used for multivariate analysis.The analysis of peripheral blood indexes and curative effect before and after treatment was compared with the Wilcoxon method of two related samples in the non-parametric test.P<0.05 indicates that the difference is statistically significant.Results:1.Efficacy analysis:A total of 200 patients with lung cancer were included,all of which can be evaluated for efficacy,with 35 cases of partial remission,140 cases of stable disease,and 25 cases of disease progression.Univariate analysis showed that the presence or absence of liver metastasis,PD-1/PD-L1 inhibitors,the number of immunotherapy lines,immunotherapy regimens,NLR,and LDH were related to the efficacy of immunotherapy.Multivariate analysis showed that no liver metastasis,immune combined chemotherapy,NLR≤2.81,LDH≤202.5U/L had better curative effect(P<0.05).The AUC value of the two indicators(NLR,LDH)jointly predicted by the receiver operating curve(ROC)was calculated to be 0.698(P<0.05).2.Survival analysis:univariate analysis suggested that the immunotherapy regimen,the number of immunotherapy lines,liver metastasis,and LDH value were related to the patient’s PFS(P<0.05).Multivariate analysis indicated that the PFS of patients without liver metastasis and LDH≤202.5U/L(P<0.05)was longer.3.Exploratory analysis of the efficacy of peripheral blood index evaluation:The values of peripheral blood index ALC,PLT,NLR,FIB,LDH,IL-6 were significantly different between before and after treatment(P<0.05).A comprehensive analysis of the changes in these indicators before and after treatment in different groups of patients can be found:ANC,PLT,NLR,FIB,and IL-6 were significantly reduced in the partial remission group(P<0.05),and ANC,PLT,NLR,and FIB were not The remission group decreased slightly(P<0.05).ANC,PLT,NLR,FIB,and IL-6 decreased significantly in the disease control group(P<0.05),ALP was significantly higher in the disease progression group(P<0.05).The decline after NLR and LDH treatment has the greatest correlation with the efficacy of immunotherapy.Conclusions:1.No liver metastasis before treatment,NLR≤2.81,LDH≤202.5U/L,and immune combined chemotherapy are all predictors of immunotherapy efficacy;among them,the combined predictive value of NLR and LDH is higher.2.No liver metastasis before treatment,LDH≤202.5U/L is an independent prognostic factor of immunotherapy.3.The changes of peripheral blood index NLR and LDH are related to the efficacy of PD-1/PD-L1 inhibitors. |
