外周血单核细胞和中性粒细胞计数预测转移性非小细胞肺癌患者对免疫检查点抑制剂反应的临床价值

目的探讨外周血单核细胞和中性粒细胞计数预测转移性非小细胞肺癌(mNSCLC)患者对免疫检查点抑制剂(ICI)治疗反应的临床价值。方法回顾性研究2017年1月至2019年3月在海南省儋州市人民医院接受纳武利尤单抗或帕博利珠单抗治疗的34例成年mNSCLC患者资料,记录并分析患者的人口学特征、临床资料、开始治疗前2周内和ICI治疗后2周血液学检查结果与预后的相关性。结果对ICI治疗有反应患者的基线中位单核细胞计数和中性粒细胞计数均低于无反应患者(0.52±0.09)×10⁹/L比(0.60±0.12)×10⁹/L,(4.27±0.87)×10⁹/L比(5.39±1.02)×10⁹/L],差异均有统计学意义(t值分别为-2.572、-2.727,均P<0.05)。对ICI治疗有反应患者的单核细胞计数与反应时间呈负相关(r=-0.507,P<0.05)。单核细胞计数>0.70×10⁹/L患者的中位反应时间短于单核细胞计数≤0.70×10⁹/L的患者(8周比12周),差异有统计学意义(χ²=4.162,P=0.041)。单核细胞计数与反应持续时间、无进展生存及总生存之间均无相关性(r值分别为-0.214、0.182、0.232,均P>0.05)。对ICI治疗有反应患者的中性粒细胞计数降低22%,高于无反应患者的2%,差异有统计学意义(P<0.05)。首次给药后中性粒细胞计数截断值为4.2×10⁹/L,中性粒细胞计数≤4.2×10⁹/L患者的反应率高于>4.2×10⁹/L患者86.7%(13/15)比36.8%(7/19)],差异有统计学意义(χ²=6.657,P<0.05)。结论外周血单核细胞和中性粒细胞计数对mNSCLC患者ICI治疗反应具有一定预测价值。

Clinical value of peripheral monocyte and neutrophil count in predicting the response of patients with metastatic non-small cell lung cancer to immunosuppressive checkpoint inhibitors

Objective To investigate the clinical value of peripheral monocyte and neutrophil count in predicting the response of patients with metastatic non-small cell lung cancer(mNSCLC)to immunosuppressive checkpoint inhibitors(ICI).Methods The clinical data of 34 adult mNSCLC patients who received nafulizumab or pabolizumab in Danzhou People's Hospital of Hainan Province from January 2017 to March 2019 were retrospectively analyzed.The correlation of the demographic characteristics,clinical data,hematological examination results in the first two weeks before the treatment and two weeks after ICI treatment with prognosis was recorded and observed.Results The baseline mean monocyte count(0.52±0.09)×10⁹/L vs.(0.60±0.12)×10⁹/L]and neutrophil count(4.27±0.87)×10⁹/L vs.(5.39±1.02)×10⁹/L]of patients with ICI reaction were lower than those of patients without ICI reaction,and the differences were statistically different(t=-2.572,-2.727,all P<0.05).However,there was a negative correlation between the monocyte count of the patients who responded to ICI and the reaction time(r=-0.507,P<0.05).The median reaction time in patients with monocyte count>0.70×10⁹/L was shorter than that in patients with monocyte count≤0.70×10⁹/L(8 weeks vs.12 weeks,χ²=4.162,P=0.041).There was no correlation between monocyte count and time of reaction duration,progression of free survival(PFS)and overall survival(OS)(r=-0.214,0.182,0.232,all P>0.05).The decrease rate of neutrophil count in response group was higher than that in non-response group(22%vs.2%,P<0.05).After the first administration,cutoff value of neutrophil count was 4.2×10⁹/L;the response rate of patients with neutrophil count≤4.2×10⁹/L was higher than that of patients with neutrophil count>4.2×10⁹/L86.7%(13/15)vs.36.8%(7/19),χ²=6.657,P<0.05].Conclusion Peripheral blood monocyte and neutrophil count can predict the response to ICI therapy in patients with mNSCLC.