目的:免疫检查点抑制剂(ICIs)在食管癌(EC)的治疗中起着重要作用。然而,很少有患者能长期生存,一些患者出现严重的免疫相关不良事件(irAEs)。需要建立疗效和安全性的可靠预测生物标志物以提高疗效。我们回顾性分析了昭和大学纳武单抗单药治疗EC的结果,医学部,确定受益于ICI单药治疗的患者的生物标志物和特征。
方法:本研究纳入了86例接受纳武单抗单药治疗的EC患者。患者特征,功效,并对安全性进行了分析。多变量分析评估了总生存期(OS)之间的相关性,无进展生存期(PFS),最佳总体反应(BOR),irAE,和以下变量:性别,年龄,性能状态(PS),中性粒细胞与淋巴细胞比率(NLR),C反应蛋白(CRP)水平,白蛋白水平,治疗前的体重指数。
结果:PFS中位数为3.1个月,中位OS为9.0个月。在多变量分析中,预处理PS,NLR,性别与OS和PFS显著相关。NLR<3.3预测生存期更长(中位OS17.5vs.6.4个月,NLR≥3.3;p<0.001)。PS0-1的中位OS为10.6个月,PS2-3的中位OS为1.3个月(p<0.001)。NLR在PS0-1组中保持显著的预测。irAE的发展与OS和PFS的增加显著相关。
结论:治疗前NLR低和PS良好的患者可以最大限度地提高ICIs的益处。低NLR可能是抗肿瘤免疫的较高免疫活性的指标,表明NLR在日常实践中可能是一种方便的预测生物标志物。
OBJECTIVE: Immune checkpoint inhibitors (ICIs) play an important role in the treatment of esophageal cancer (EC). However, few patients achieve long-term survival, and some patients develop serious immune-related adverse events (irAEs). Reliable predictive biomarkers of efficacy and safety need to be established in order to improve efficacy. We retrospectively analyzed the outcomes of nivolumab monotherapy on EC at Showa University, Department of Medicine, to identify biomarkers and characteristics of patients who benefit from ICI monotherapy.
METHODS: Eighty-six patients with EC who received nivolumab monotherapy were included in the present study. Patient characteristics, efficacy, and safety were analyzed. A multivariable analysis evaluated the correlation among overall survival (OS), progression-free survival (PFS), best overall response (BOR), irAEs, and the following variables: sex, age, performance status (PS), neutrophil-to-lymphocyte ratio (NLR), C-reactive protein (CRP) level, albumin level, and body-mass index before treatment.
RESULTS: Median PFS was 3.1 months, and median OS was 9.0 months. In multivariable analysis, pretreatment PS, NLR, and sex were significantly correlated with OS and PFS. NLR <3.3 predicted longer survival (median OS 17.5 vs. 6.4 months for NLR ≥3.3; p<0.001). Median OS was 10.6 months for PS 0-1 and 1.3 months for PS 2-3 (p<0.001). NLR remained significantly predictive in the PS 0-1 group. The development of irAEs was significantly associated with increased OS and PFS.
CONCLUSIONS: Patients with low NLR and good PS before treatment may maximize the benefits of ICIs. A low NLR may be an indicator of higher immunocompetence for anti-tumor immunity, suggesting that NLR may be a convenient predictive biomarker in daily practice.