Pretreatment neutrophil-to-lymphocyte ratio as a marker of outcomes in nivolumab-treated patients with advanced non-small-cell lung cancer
Pretreatment neutrophil-to-lymphocyte ratio as a marker of outcomes in nivolumab-treated patients with advanced non-small-cell lung cancer
复制标题
DOI：
10.1016/j.lungcan.2017.01.013
复制
发表时间：
2017-04-01
期刊：
影响因子：
5.3
通讯作者：
Langer, Corey J.
中科院分区：
文献类型：
--
作者：
Bagley, Stephen J.;Kothari, Shawn;Langer, Corey J.
nivolumab在非小细胞肺癌（NSCLC）中的有效应用受到缺乏明确预测性生物标志物的限制。在接受ipilimumab治疗的转移性黑色素瘤患者中，预处理中性粒细胞与淋巴细胞比率(NLR) < 5与生存率的提高有关。这项回顾性队列研究旨在确定预处理NLR是否与接受纳武单抗治疗的NSCLC患者的预后相关。方法：我们回顾了2015年3月至2016年3月在宾夕法尼亚大学的临床试验之外接受过nivolumab治疗的所有晚期NSCLC患者的医疗记录。根据预处理NLR < 5和> 5对患者进行二分类。采用多变量logistic回归和Cox比例风险模型评估预处理NLR对总生存期（OS）、无进展生存期（PFS）和总缓解率（ORR）的影响。结果：治疗175例。中位年龄为68岁（范围33-88岁）；54%是女性。25%的患者达到东部肿瘤合作组绩效状态（ECOG PS） bb0.2；46%的患者先前接受过全身治疗。在多变量分析中，预处理中性粒细胞与淋巴细胞比率（NLR） bbb5与较差的OS（中位5.5 vs. 8.4个月；HR 2.07, 95% CI 1.3-3.3; p=0.002）和较差的PFS（中位1.9 vs. 2.8个月；HR 1.43, 95% CI 1.02-2.0; p=0.04）独立相关。结论：在一组常规使用纳武单抗治疗的NSCLC患者中，预处理NLR bb50与较差的预后相关。目前尚不清楚该标志物是预测性的还是预后性的。有必要进行前瞻性研究，以确定NLR在程序性死亡-1 （PD-1）治疗的其他生物标志物中的效用。(C) 2017 Elsevier B.V.版权所有
Objectives: Efficient use of nivolumab in non-small-cell lung cancer (NSCLC) has been limited by the lack of a definitive predictive biomarker. In patients with metastatic melanoma treated with ipilimumab, a pretreatment neutrophil-to-lymphocyte ratio (NLR) < 5 has been associated with improved survival. This retrospective cohort study aimed to determine whether the pretreatment NLR was associated with outcomes in NSCLC patients treated with nivolumab.Methods: We reviewed the medical records of all patients with previously treated advanced NSCLC who received nivolumab between March 2015 and March 2016 outside of a clinical trial at the University of Pennsylvania. Patients were dichotomized according to pretreatment NLR < 5 vs. > 5. Multivariable logistic regression and Cox proportional hazards models were used to assess the impact of pretreatment NLR on overall survival (OS), progression-free survival (PFS), and overall response rate (ORR).Results: 175 patients were treated. Median age was 68 (range, 33-88); 54% were female. Twenty-five percent of patients had an Eastern Cooperative Oncology Group Performance Status (ECOG PS) > 2; 46% had received > 2 prior systemic therapies. In multivariate analyses, pretreatment neutrophil-to-lymphocyte ratio (NLR) > 5 was independently associated with inferior OS (median 5.5 vs. 8.4 months; HR 2.07, 95% CI 1.3-3.3; p=0.002) and inferior PFS (median 1.9 vs. 2.8 months; HR 1.43, 95% CI 1.02-2.0; p=0.04).Conclusions: In a cohort of patients with NSCLC treated with nivolumab in routine practice, pretreatment NLR > 5 was associated with inferior outcomes. It is unclear whether this marker is predictive or prognostic. Prospective studies are warranted to determine the utility of NLR in the context of other biomarkers of programmed death-1 (PD-1) therapy. (C) 2017 Elsevier B.V. All rights reserved.