■免疫检查点抑制剂(ICIs)重塑了小细胞肺癌(SCLC)的治疗前景,但只有少数患者从这种治疗中受益。因此,至关重要的是,确定可预测SCLC患者ICI治疗疗效的潜在危险因素,并确定可能从ICI治疗中获益最大的患者亚组.
■我们的研究包括总共183名接受至少一次ICI治疗的SCLC患者。我们利用逻辑回归和Cox比例风险回归来评估各种患者临床因素和血清生物标志物是否可以作为ICI治疗期间患者对治疗的反应和总生存期(OS)的预测因子。
■Logistic回归显示,有手术史(p=0.003,OR9.06,95%CI:(2.17,37.9))和无转移(p=0.008,OR7.82,95%CI:(1.73,35.4))的患者对ICI治疗有较高的应答几率。Cox回归分析表明,治疗前的血白蛋白(p=0.003,HR1.72,95%CI:(1.21,2.45))和衍生的中性粒细胞与淋巴细胞比率(dNLR)(p=0.003,HR1.71,95%CI:(1.20-2.44))是SCLC患者OS的独立预测因子。通过建立基于基线白蛋白和dNLR的治疗前预后评分系统,我们发现,高白蛋白和低dNLR患者在完整队列(P<.0001,HR0.33,95%CI:0.20-0.55)和转移队列(P<.0001,HR0.28,95%CI:0.15-0.51)中的预后明显优于低白蛋白和高dNLR患者.预后较好的组年龄也较小,与不良组相比,BMI较高,全身炎症生物标志物值较低(P<0.0001)。
■我们的数据揭示了转移状态和治疗史在预测SCLC患者对ICI治疗的初始反应中的重要作用。然而,基线血清白蛋白和dNLR为患者OS提供了更精确的预后预测.基于白蛋白和dNLR的评分系统增强了对患者预后进行分层的能力,并有可能指导接受ICI治疗的SCLC患者的临床决策。
UNASSIGNED: Immune checkpoint inhibitors (ICIs) have reshaped the treatment landscape of small cell lung cancer (
SCLC), but only a minority of patients benefit from this therapy. Therefore, it is critical to identify potential risk factors that could predict the efficacy of ICI treatment in
SCLC patients and identify patient subgroups who may benefit the most from ICI therapy.
UNASSIGNED: Our study included a total of 183
SCLC patients who had received at least one dose of ICI treatment. We utilized both logistic regression and Cox proportional hazard regression to evaluate whether various patient clinical factors and serum biomarkers could serve as predictors of patient response to treatment and overall survival (OS) during ICI therapy.
UNASSIGNED: Logistic regression showed that patients with a history of surgery (p=0.003, OR 9.06, 95% CI: (2.17, 37.9)) and no metastasis (p=0.008, OR 7.82, 95% CI: (1.73, 35.4)) exhibited a higher odds of response to ICI treatment. Cox regression analyses demonstrated that pretreatment blood albumin (p=0.003, HR 1.72, 95% CI: (1.21, 2.45)) and derived neutrophil to lymphocyte ratio (dNLR) (p=0.003, HR 1.71, 95% CI: (1.20-2.44)) were independent predictors for OS in
SCLC patients. By establishing a pre-treatment prognostic scoring system based on baseline albumin and dNLR, we found that patients with high albumin and low dNLR exhibited a significantly better prognosis than those with low albumin and high dNLR in both the full (P<.0001, HR 0.33, 95% CI: 0.20-0.55) and the metastatic cohort (P<.0001, HR 0.28, 95% CI: 0.15-0.51). The better prognostic group also had younger age, higher BMI and lower systemic inflammatory biomarker values than the unfavorable group (P<.0001).
UNASSIGNED: Our data reveals the significant role of metastasis status and treatment history in predicting the initial response of SCLC patients to ICI treatment. However, baseline serum albumin and dNLR provide a more precise prognostic prediction for patient OS. The scoring system based on albumin and dNLR enhances the ability to stratify patient prognosis and holds the potential to guide clinical decision-making for
SCLC patients undergoing ICI therapy.