非小细胞肺癌免疫治疗前后NLR和PLR变化及对免疫治疗疗效的预测价值

目的:探讨中性粒细胞/淋巴细胞比值(neutrophil to lymphocyte ratio，NLR)和血小板/淋巴细胞比值(platelet to lymphocyte ratio，PLR)及其动态变化对非小细胞肺癌（non-small cell lung cancer,NSCLC）免疫治疗疗效和预后的影响。方法:回顾性分析2018年10月至2020年2月我院收治的所有接受过nivolumab治疗的NSCLC患者32例，收集免疫治疗前和2周期治疗后的NLR和PLR，应用Kaplan-Meier方法进行生存分析，单因素和Cox多因素分析NLR、PLR及其动态变化和各种临床特征与免疫治疗疗效和无进展生存期之间的关系。结果:两周期免疫治疗后，NLR2较NLR0显著下降，分别为（3.25±2.80）和（3.94±2.36）（P=0.034 9）；PLR2同PLR0相比无显著变化，分别为（165.75±114.25）和（197.09±79.90）（P=0.122 0）；单因素分析显示PFS与NLR0、NLR2、PLR0、PLR2、分期有关（P＜0.05）；多因素分析表明NLR0（P=0.011）、分期（P=0.029）是PFS的独立预测因素。结论:较高的NLR0与PLR0患者的PFS更短，NLR的动态变化与患者的免疫治疗疗效显著相关。因此，NLR与PLR是预测NSCLC免疫治疗疗效和预后的理想指标。

Changes of NLR and PLR before and after immunotherapy for non-small cell lung cancer and predictive value for the prognosis of immunotherapy

Objective:To investigate the effects of neutrophil to lymphocyte ratio(NLR)and platelet to lymphocyte ratio(PLR)and their dynamic changes on the efficacy and prognosis of non-small cell lung cancer immunotherapy influences.Methods:A retrospective analysis of 32 cases of NSCLC treated with nivolumab in the First Affiliated Hospital of Bengbu Medical College from October 2018 to February 2020 was performed.NLR and PLR before immunotherapy and after two cycles of treatment were collected.Kaplan-Meier method was used for survival analysis.Single factor and Cox multivariate analysis evaluated NLR,PLR and their dynamic changes and the relationship between various clinical features and immunotherapy efficacy and progression-free survival.Results:After immunotherapy,NLR2 decreased significantly compared with NLR0,respectively(3.25±2.80)and(3.94±2.36)(P=0.0349).PLR2 did not change significantly compared with PLR0,respectively(165.75±114.25)and(197.09±79.90)(P=0.1220).Univariate analysis showed that PFS was related to NLR0,NLR2,PLR0,PLR2,staging(P<0.05).Multivariate analysis showed that NLR0(P=0.011),staging(P=0.029)was an independent predictor of PFS factor.Conclusion:Patients with high NLR0 and high PLR0 have shorter PFS,and the dynamic changes of NLR are significantly related to the efficacy of immunotherapy.Therefore,NLR and PLR are ideal indicators to predict the efficacy and prognosis of NSCLC immunotherapy.