Correlation Between T-Lymphocyte Subsets And Chemotherapy Efficacy In NSCLC Patients

Objective:The aim of this study was to investigate the efficacy of platinum-based chemotherapy in patients with NSCLC,to analyze the relationship between peripheral blood lymphocyte subsets and efficacy,and to investigate the role of peripheral immune characteristics in the treatment of NSCLC patients.Methods:Clinical data of patients with NSCLC diagnosed in the Cancer Hospital of Anhui University of Technology were collected from Dec 2021 to Aug 2022.A total of 156patients with NSCLC were included in the study,including 62 patients with platinum-based chemotherapy,47 patients with chemotherapy+radiotherapy,and 47patients with chemotherapy+targeted therapy.Flow cytometry was also applied to detect the peripheral blood lymphatic subpopulation index of patients before treatment.First,the differential expression of 17 peripheral lymphatic subgroups in the chemotherapy-sensitive group(PR group)and the insensitive group(SD+PD group)was analyzed by correlation comparison and t-test comparison.Secondly,various independent factors affecting the efficacy of platinum-based chemotherapy were explored in depth by univariate and multifactorial logistic regression analysis,and a prediction model for platinum-based chemotherapy insensitivity was developed.Evaluation of the differentiation of the prediction models by ROC curves.Visualization of the prediction model using column line plots.Subsequently,in the chemotherapy PR group,independent risk factors for the occurrence of toxic side effects in the chemotherapy PR group were searched for using univariate and multifactorial logistic regression and linear fitting methods.Finally,in the chemotherapy SD+PD group,the clinical characteristics of the populations in the chemotherapy SD+PD and chemo+radiotherapy and chemo+targeted groups were matched(P>0.05),and the efficacy benefit between the three groups was analyzed by curve-fitting methods.Results:First,the percentage and absolute counts of CD28+CD8+T and CD38+CD4+T were significantly higher in the platinum chemotherapy-sensitive group(PR group)than in the platinum chemotherapy-insensitive group(SD+PD group),whereas the percentage and absolute counts of PD1+CD4+T were significantly lower than in the SD+PD group,and this result was statistically significant(P<0.05).Logistic regression revealed that all three lymphocyte subsets,CD28+CD8+T%,CD38+CD4+T%,and PD1+CD4+T%,were independent factors that could differentiate chemotherapy efficacy(P<0.05).The efficacy of all three markers was superior to that of the tumor marker target CEA+CYFRA211(CD8+CD28+T%:AUC(0.696,95%CI:0.5687,0.836);CD38+CD4+T%:AUC(0.672,95%CI:0.5340,0.809);PD1+CD4+T%:AUC(0.869,95%CI:0.7791,0.960);CEA+CYFRA211:AUC(0.619,95%CI:0.4755,0.762)).And the combined index of these 3 lymphatic subgroups had better efficacy than the single lymphatic subgroup index(AUC=0.916,95%CI:0.8429,0.988).The prediction model constructed by the combination of the 3 lymphocyte subpopulations can be defined as<-0.6179 for the PR group and>-0.6179 for the SD+PD group with platinum-based chemotherapy according to the optimal threshold.In the platinum-based chemotherapy SD+PD group,PR rates were improved compared with those in the chemo+radiotherapy and chemo+targeted groups.Curve fitting revealed that both chemo+radiotherapy and chemo+targeted therapy improved the efficacy of the chemotherapy-insensitive population.(Chemo-insensitivity:PR=20%;Chemoradiotherapy:PR=39%;Chemo+Targeted:PR=38%).In the platinum-based chemotherapy PR group,HLADR+CD8+%was found to be an independent protective factor for the development of myelosuppression in the PR group(OR=0.88,95%CI=0.79-0.98,P=0.0168).for every 1%increase in HLADR+CD8+,the risk of myelosuppression decreased by 12%.Conclusion:This study showed that pretreatment peripheral blood lymphatic subsets were markers to distinguish sensitivity to platinum-based chemotherapy.A prediction model constructed from the combination of preoperative CD28~+CD8~+T%,CD38~+CD4~+T%,and PD1~+CD4~+T%worked well.People who are not sensitive to chemotherapy should undergo radiotherapy+chemotherapy or targeted+chemotherapy as early as possible.HLADR~+CD8~+%was an independent protective factor for the development of myelosuppression in the chemotherapy-sensitive group.Figure[11]Table[9]Reference[87]...