Platelet-related indices in patients with lung cancer with nivolumab
Platelet-related indices in patients with lung cancer with nivolumab
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纳武利尤单抗治疗肺癌患者的血小板相关指标
DOI：
10.1080/09537104.2017.1356454
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发表时间：
2017
期刊：
影响因子：
3.3
通讯作者：
Kurata Takayasu
中科院分区：
文献类型：
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作者：
Nomura Shosaku;Yokoi Takashi;Kurata Takayasu
我们感兴趣地阅读了Pyo等人最近的评论。[1]平均血小板体积（MPV）在恶性肿瘤中的诊断和预后作用。作者报告称，恶性肿瘤患者的MPV水平显著高于健康受试者，并在治疗后下降。MPV代表血液中血小板的平均大小，也可能反映血小板活性。肺癌的一线治疗包括铂类化疗，作为大多数晚期非小细胞肺癌（NSCLC）患者的标准治疗，无合并症且体能状态最佳[2]。然而，使用免疫检查点抑制剂（ICI）治疗NSCLC是一种最近的方法，已引起了极大的兴趣。一种这样的ICI是程序性死亡（PD）-1抑制剂纳武单抗（nivolumab），其在美国被批准用于治疗疾病进展或在基于铂的化疗后的转移性NSCLC患者，作为宿主免疫应答和炎症状态的副肿瘤替代指标，嗜血小板-淋巴细胞比率（NLR）和血小板-淋巴细胞比率（PLR）的预后价值已在多种癌症中得到证实[3]。此外，血小板指数如血小板计数、MPV和血小板分布（PDW）可用于评估肺癌或组织学[4]。尽管已经报道了nivolumab治疗的NSCLC患者中NLR的意义[5]，但对nivolumab治疗后的血小板指数知之甚少。因此，我们评估了NSCLC患者接受纳武单抗治疗后的血小板指数。我们招募了52名接受nivolumab治疗的NSCLC患者，并根据nivolumab剂量周期将其分配到两组中的一组。良好的治疗反应导致PD-1抗体的剂量周期增加，但进展失败与治疗中止相关。我们比较了两组，其中30名良好反应者（GR）接受纳武单抗超过12个周期，22名不良反应者（BR）接受少于3个周期（表I）。我们分析了初始纳武单抗治疗后2周测量的血小板指数，发现BR组的血小板计数和PLR显著高于GR组。相反，BR组的PDW、MPV和血小板大细胞比率（P-LCR）[6]显著低于GR组。P-LCR是较大血小板循环（> 12 fl）的指标，也用于监测血小板活性
We read with interest the recent review by Pyo et al.[1] on the diagnostic and prognostic role of mean platelet volume (MPV) in malignant tumors. The authors reported that the MPV level was significantly higher in patients with malignant tumors than in healthy subjects, and decreased following treatment. MPV represents the average platelet size in the bloodstream and may also reflect platelet activity.The first-line treatment of lung cancer includes platinumbased chemotherapy as standard for the majority of patients with advanced non-small cell lung cancer (NSCLC), without comorbidities and with optimal performance status [2]. However, the use of immune check point inhibitors (ICIs) to treat NSCLC is a recent approach which has generated significant interest. One such ICI is the programmed death (PD)-1 inhibitor nivolumab, which is approved in the United States for the treatment of metastatic NSCLC in patients with disease progression or following platinum-based chemotherapy As a paraneoplastic surrogate index for host immune response and inflammation status, the prognostic value of neutrophil-tolymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) has been demonstrated in a variety of cancers [3]. In addition, platelet indices such as platelet count, MPV, and platelet distribution (PDW) can be used to evaluate lung cancer or histology [4]. Although the significance of NLR in nivolumab-treated patients with NSCLC has been reported [5], platelet indices after nivolumab treatment are poorly understood. We therefore evaluated platelet indices after nivolumab treatment in patients with NSCLC. We recruited 52 nivolumab-treated patients with NSCLC and assigned them to one of two groups according to nivolumab dosage cycle. Good treatment response resulted in increased dosage cycles of PD-1 antibody, but failure to progress was associated with treatment discontinuation. We compared the two groups, which were 30 good responders (GR) received nivolumab for more than 12 cycles and 22 bad responders (BR) received less than 3 cycles (Table I). We analyzed the platelet indices measured 2 weeks after initial nivolumab treatment, and found that platelet count and PLR were significantly higher in the BR group than in the GR group. In contrast, PDW, MPV, and platelet large cell ratio (P-LCR)[6] were significantly lower in the BR group than in the GR group. P-LCR is an indicator of larger platelet circulating (> 12fl) and has also been used to monitor platelet activity