Prognostic and predictive value of neutrophil-to-lymphocyte ratio with adjuvant immunotherapy in stage III non-small-cell lung cancer.
Prognostic and predictive value of neutrophil-to-lymphocyte ratio with adjuvant immunotherapy in stage III non-small-cell lung cancer.
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DOI：
10.1016/j.lungcan.2021.11.021
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发表时间：
2022-01
期刊：
影响因子：
--
通讯作者：
Green MD
中科院分区：
文献类型：
--
作者：
Bryant AK;Sankar K;Strohbehn GW;Zhao L;Elliott D;Qin A;Yentz S;Ramnath N;Green MD
治疗前嗜中性粒细胞与淋巴细胞比率（NLR）升高可能反映免疫功能障碍，并且在接受免疫治疗的癌症患者中具有不良预后，但目前尚不清楚NLR是否可预测免疫治疗的益处。我们确定了2017年至2021年在国家退伍军人事务系统中接受确定性放化疗和辅助durvalumab治疗的III期非小细胞肺癌（NSCLC）患者。我们比较了在durvalumab开始治疗前测量的NLR的预后价值，以及在durvalumab辅助治疗获批前，从2015年至2016年仅接受明确放化疗的III期NSCLC患者对照组（无durvalumab组）。我们通过durvalumab组与NLR水平的统计学相互作用来估计NLR的预测值。结局包括无进展生存期（PFS）和总生存期（OS）。NLR的主要分析包括821名durvalumab患者和445名无durvalumab患者。在两组中，较高的NLR与较差的PFS相关（无durvalumab：NLR每增加7.43单位，校正HR [aHR] 1.14，95%置信区间[CI] 1.06-1.23; durvalumab：aHR 1.42，95% CI 1.23-1.64），尽管在durvalumab患者中该效应更大（相互作用p =0.009）。OS结果相似（无durvalumab：aHR 1.16，95% CI 1.09-1.24; durvalumab：aHR 1.48，95% CI 1.25-1.76;相互作用p = 0.010）。绝对淋巴细胞、嗜酸性粒细胞和嗜碱性粒细胞在两组中均无预后意义。durvalumab治疗疗效的估计值表明，随着NLR的升高，疗效下降。与未接受免疫治疗的对照患者相比，接受辅助免疫治疗的III期NSCLC患者的治疗前NLR尤其具有预后性，并且可能是免疫治疗获益的预测性生物标志物。
Elevated pre-treatment neutrophil-to-lymphocyte ratio (NLR) may reflect immune dysfunction and is negatively prognostic in cancer patients treated with immunotherapy, but it is unclear if NLR is predictive of immunotherapy benefit. We identified stage III non-small-cell lung cancer (NSCLC) patients treated with definitive chemoradiation and adjuvant durvalumab within the national Veterans Affairs system from 2017 to 2021. We compared the prognostic value of NLR measured before durvalumab start to a control group of stage III NSCLC patients treated with definitive chemoradiation alone from 2015–2016 (no-durvalumab group) before the approval of adjuvant durvalumab. We estimated the predictive value of NLR through the statistical interaction of durvalumab group by NLR level. Outcomes included progression-free survival (PFS) and overall survival (OS). The primary analysis for NLR included 821 durvalumab patients and 445 no-durvalumab patients. Higher NLR was associated with inferior PFS in both groups (no-durvalumab: adjusted HR [aHR] 1.14 per 7.43 unit increase in NLR, 95% confidence interval [CI] 1.06–1.23; durvalumab: aHR 1.42, 95% CI 1.23–1.64), though this effect was greater in durvalumab patients (p for interaction=0.009). Similar results were found for OS (no-durvalumab: aHR 1.16, 95% CI 1.09–1.24; durvalumab: aHR 1.48, 95% CI 1.25–1.76; p for interaction = 0.010). Absolute lymphocytes, eosinophils, and basophils were not prognostic in either group. Estimates of durvalumab treatment efficacy suggested declining efficacy with higher NLR. Pre-treatment NLR is especially prognostic among stage III NSCLC patients treated with adjuvant immunotherapy compared to control patients treated without immunotherapy and may be a predictive biomarker of immunotherapy benefit.
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