Post-radiation neutrophil-to-lymphocyte ratio is a prognostic marker in patients with localized pancreatic adenocarcinoma treated with anti-PD-1 antibody and stereotactic body radiation therapy.
Post-radiation neutrophil-to-lymphocyte ratio is a prognostic marker in patients with localized pancreatic adenocarcinoma treated with anti-PD-1 antibody and stereotactic body radiation therapy.
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DOI：
10.3857/roj.2021.01060
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发表时间：
2022-06
影响因子：
2.3
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研究立体定向体部放射治疗（SBRT）前后嗜中性粒细胞/淋巴细胞比率（NLR）在接受抗PD-1（程序性细胞死亡蛋白-1）抗体和SBRT治疗的局限性胰腺癌患者中的作用。这是一项对68例在多药化疗后接受抗PD-1抗体和SBRT治疗的临界可切除或局部晚期胰腺癌患者的回顾性分析。在新辅助治疗、同期治疗或辅助/维持治疗环境中使用5部分SBRT进行免疫治疗。临床结局包括总生存期（OS）、局部无进展生存期、无远处转移生存期和无进展生存期。使用Mann-Whitney U检验比较了SBRT前后外周血标志物的中位数。进行单变量和多变量分析（UVA和MVA），以确定与临床结局相关的变量。进行线性回归以确定变量与外周血标志物之间的相关性。 共有68例患者入选本研究。SBRT前后中位绝对淋巴细胞计数（ALC）、绝对中性粒细胞计数和NLR之间的百分比变化分别为-36.0%（p < 0.001）、-5.6%（p = 0.190）和+35.7%（p = 0.003）。SBRT后的中位OS为22.4个月。UVA时，SBRT前CA 19 -9（风险比[HR] = 1.001; 95%置信区间[CI]，1.000-1.001; p = 0.031），SBRT后ALC（HR = 0.33; 95% CI，0.11-0.91; p = 0.031）和SBRT后NLR（HR = 1.13; 95% CI，1.04-1.22; p = 0.009）与OS相关。（HR = 0.75; 95% CI，0.57-0.99; p = 0.048）和SBRT后NLR（HR = 1.14; 95% CI，1.04-1.23; SBRT后NLR ≥3.2的患者的中位OS为15.6个月，而SBRT后NLR <3.2的患者的中位OS为27.6个月（p = 0.009）。在MVA线性回归中，log 10 CTV与SBRT后ALC呈负相关（回归系数= -0.314; 95% CI，-0.626至-0.003; p = 0.048）。 SBRT后NLR升高主要是由于淋巴细胞耗竭，并与抗PD-1抗体治疗的局部胰腺癌的生存结局较差相关。较大的CTV与SBRT后ALC降低相关。
To investigate the role of pre- and post-stereotactic body radiation therapy (SBRT) neutrophil-to-lymphocyte ratio (NLR) in patients with localized pancreatic cancer treated with anti-PD-1 (programmed cell death protein-1) antibody and SBRT. This was a retrospective review of 68 patients with borderline resectable or locally advanced pancreatic cancer treated with anti-PD-1 antibody and SBRT after multi-agent chemotherapy. Immunotherapy was administered with 5-fraction SBRT in the neoadjuvant, concurrent, or adjuvant/maintenance setting. Clinical outcomes included overall survival (OS), local progression-free survival, distant metastasis-free survival, and progression-free survival. Median pre- and post-SBRT peripheral blood markers were compared with the Mann-Whitney U test. Univariate and multivariable analyses (UVA and MVA) were performed to identify variables associated with clinical outcomes. Linear regression was performed to determine correlations between variables and peripheral blood markers. A total of 68 patients were included in the study. The percent change between median pre- and post-SBRT absolute lymphocyte count (ALC), absolute neutrophil count, and NLR were -36.0% (p < 0.001), -5.6% (p = 0.190), and +35.7% (p = 0.003), respectively. Median OS after SBRT was 22.4 months. On UVA, pre-SBRT CA19-9 (hazard ratio [HR] = 1.001; 95% confidence interval [CI], 1.000–1.001; p = 0.031), post-SBRT ALC (HR = 0.33; 95% CI, 0.11–0.91; p = 0.031), and post-SBRT NLR (HR = 1.13; 95% CI, 1.04–1.22; p = 0.009) were associated with OS. On MVA, induction chemotherapy duration (HR = 0.75; 95% CI, 0.57–0.99; p = 0.048) and post-SBRT NLR (HR = 1.14; 95% CI, 1.04–1.23; p = 0.002) predicted for OS. Patients with post-SBRT NLR ≥3.2 had a median OS of 15.6 months versus 27.6 months in patients with post-SBRT NLR <3.2 (p = 0.009). On MVA linear regression, log10CTV had a negative correlation with post-SBRT ALC (regression coefficient = -0.314; 95% CI, -0.626 to -0.003; p = 0.048). Elevated NLR after SBRT is primarily due to depletion of lymphocytes and associated with worse survival outcomes in localized pancreatic cancer treated with anti-PD-1 antibody. Larger CTVs were associated with decreased post-SBRT ALC.