Association of Lymphocyte-to-Monocyte Ratio With Survival in Advanced Gastric Cancer Patients Treated With Immune Checkpoint Inhibitor.
Association of Lymphocyte-to-Monocyte Ratio With Survival in Advanced Gastric Cancer Patients Treated With Immune Checkpoint Inhibitor.
复制标题
淋巴细胞与单核细胞比率与接受免疫检查点抑制剂治疗的晚期胃癌患者生存的关系
DOI：
10.3389/fonc.2021.589022
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发表时间：
2021
影响因子：
4.7
通讯作者：
Shen L
中科院分区：
文献类型：
--
作者：
Chen Y;Zhang C;Peng Z;Qi C;Gong J;Zhang X;Li J;Shen L
背景接受免疫检查点抑制剂（ICI）治疗的胃癌患者缺乏最佳预后生物标志物。包括淋巴细胞与单核细胞比率（LMR）、血小板与淋巴细胞比率（PLR）和全身炎症指数（SII）在内的炎症标志物很容易获得。然而，其与ICI在胃癌中的相关性尚不清楚。在此，我们评估了接受ICI治疗的胃癌患者的LMR、PLR和SII与临床结局之间的潜在相关性。方法我们在2015年8月至2019年4月期间在北京大学肿瘤医院（中国北京）接受ICI治疗的139例患者中检测了基线和6（± 2）周后的LMR、PLR、SII。在6周时进行里程碑分析，以探讨LMR、PLR和SII对无进展生存期（PFS）和总生存期（OS）的预后价值。使用考克斯比例风险模型计算LMR的死亡风险比（HR），调整潜在混杂因素，包括年龄、性别、ECOG、肿瘤位置、肿瘤分化、肿瘤分期、治疗线和抗PD-1/PD-L1治疗类型。结果139例患者中，男性103例（74.1%），中位年龄60岁。中位治疗时间为6个周期。我们观察到基线和第6周的LMR都是独立的预后因素。LMR较高的患者基线或第6周时（≥ 3.5）的PFS和OS上级基线：HR 0.58，95%置信区间（CI）：0.38-0.91;第6周：HR 0.48，95% CI：0.29-0.78（基线：HR 0.38，95%CI：0.24-0.62;第6周：HR 0.52，95%CI：0.31-0.88）与LMR较低（< 3.5）的患者相比。此外，对于基线LMR ≥ 3.5和第6周LMR ≥ 3.5的患者，估计PFS（HR 0.41，95% CI：0.23-0.72）和OS（HR 0.34，95% CI：0.18-0.64）远优于基线LMR < 3.5和第6周LMR < 3.5的患者。结论LMR的基线和早期变化与接受ICI治疗的胃癌患者的生存率密切相关，并可能有助于识别最有可能从ICI中获益的患者。
Background Optimal prognostic biomarkers for patients with gastric cancer who received immune checkpoint inhibitor (ICI) are lacking. Inflammatory markers including lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), and systemic inflammation index (SII) are easily available. However, its correlation with ICI is unknown in gastric cancer. Here, we evaluated the potential association between LMR, PLR, and SII with clinical outcomes in gastric cancer patients undergoing ICI therapy. Methods We examined LMR, PLR, SII at baseline, and 6 (± 2) weeks later in 139 patients received ICI therapy between August 2015 and April 2019 at Peking University Cancer Hospital (Beijing, China). Landmark analysis at 6 weeks was conducted to explore the prognostic value of LMR, PLR, and SII on progress-free survival (PFS), and overall survival (OS). A Cox proportional hazards model was used to compute mortality hazard ratios (HRs) for LMR, adjusting for potential confounders including age, sex, ECOG, tumor location, tumor differentiation, tumor stage, line of therapy, and type of anti-PD-1/PD-L1 therapy. Results Among 139 patients, 103 (74.1%) were male, median age was 60 years. Median duration of therapy was 6 cycles. We observed that both LMR at baseline and week 6 were independent prognostic factors. Patients with a higher LMR (≥ 3.5) at baseline or week 6 had superior PFS [baseline: HR 0.58, 95% confidence interval (CI): 0.38–0.91; week 6: HR 0.48, 95% CI: 0.29–0.78] and OS (baseline: HR 0.38, 95% CI: 0.24–0.62; week 6: HR 0.52, 95% CI: 0.31–0.88) compared with patients with a lower LMR (< 3.5). Furthermore, for patients with both LMR ≥ 3.5 at baseline and LMR ≥ 3.5 at week 6 were estimated to have much better PFS (HR 0.41, 95% CI: 0.23–0.72) and OS (HR 0.34, 95% CI: 0.18–0.64) than patients with both LMR < 3.5 at baseline and LMR < 3.5 at week 6. Conclusions Baseline and early changes in LMR were strongly associated with survival in gastric cancer patients who received ICI therapy, and may serve to identify patients most likely to benefit from ICI.