中性粒细胞/淋巴细胞比值对晚期肺癌免疫检查点抑制剂相关性肺炎的预测价值

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摘要目的探讨外周血淋巴细胞亚群及炎症相关指标在晚期肺癌免疫检查点抑制剂相关性肺炎（CIP）发生中的预测价值。方法回顾性分析2019年2月至2021年11月山东大学齐鲁医院行PD-1/PD-L1抑制剂治疗且行淋巴细胞亚群检测的77例晚期肺癌患者的临床资料。根据是否发生CIP，将其分为CIP组（11例）和非CIP组（66例）。比较两组患者的淋巴细胞亚群水平、中性粒细胞/淋巴细胞比值（NLR）、淋巴细胞/单核细胞比值（LMR）和血小板/淋巴细胞比值（PLR）的差异，并采用ROC曲线评估各指标对CIP发生的预测价值。结果随访期间，11例患者发生了CIP，发生率14.3%。CIP组患者的基线NLR高于非CIP组，差异有统计学意义（P＜0.05）；但两组患者的淋巴细胞亚群水平、LMR和PLR比较，差异无统计学意义（P＞0.05）。ROC曲线显示，NLR对CIP预测的AUC为0.718（95%CI：0.502~0.933），截断值为4.50，敏感度为75.8%，特异度为72.7%。结论晚期肺癌患者免疫治疗前NLR可作为CIP预测指标，但淋巴细胞亚群、LMR和PLR与CIP的发生无明显相关。

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	韩利会
	田辉
	杨秋安

关键词 ：肺癌, 中性粒细胞/淋巴细胞比值, 淋巴细胞亚群, PD-1/PD-L1抑制剂, 免疫检查点抑制剂相关性肺炎

Abstract：Objective To investigate the predictive value of peripheral blood lymphocyte subsets and inflammation related indexes in the occurrence of immune checkpoint inhibitor associated pneumonia (CIP) in advanced lung cancer. Methods A retrospective analysis was performed on the clinical data of 77 patients with advanced lung cancer who received PD-1/PD-L1 inhibitor treatment and lymphocyte subsets detection in Qilu Hospital of Shandong University from February 2019 to November 2021. According to the occurrence of CIP, they were divided into CIP group (11 cases) and non-CIP group (66 cases). The levels of lymphocyte subsets, neutrophil to lymphocyte ratio (NLR), lymphocyte to monocyte ratio (LMR) and platelet/lymphocyte ratio (PLR) were compared between two groups, and the predictive value of each indicator for CIP occurrence was evaluated by ROC curve. Results During follow-up, CIP occurred in 11 patients, the incidence of 14.3%. The baseline NLR in CIP group was higher than that in non-CIP group, and the difference was statistically significant (P<0.05). However, there were no significant differences in lymphocyte subsets, LMR and PLR between two groups (P>0.05). ROC curve showed that the AUC predicted by NLR for CIP was 0.718 (95%CI: 0.502-0.933), the cut-off value was 4.50, the sensitivity was 75.8%, and the specificity was 72.7%. Conclusion NLR can be used as a predictor of CIP in advanced lung cancer patients before immunotherapy, but lymphocyte subsets, LMR and PLR have no significant correlation with CIP occurrence.

Key words： Lung cancer Neutrophil to lymphocyte ratio Lymphocyte subsets Anti-PD-1/PD-L1 immunotherapy； Checkpoint inhibitor-related pneumonitis

通讯作者: 杨秋安（1964-），男，山东济宁人，博士，副主任医师，硕士生导师，山东大学齐鲁医院东院区肿瘤放疗科主任，研究方向：头颈部肿瘤和肺癌的放射治疗及生物靶向治疗。

作者简介: 韩利会（1990-），女，山东菏泽人，山东大学2021级放射肿瘤学专业在职博士研究生，研究方向：肺癌的放射治疗和免疫治疗。

引用本文:

韩利会；田辉；杨秋安. 中性粒细胞/淋巴细胞比值对晚期肺癌免疫检查点抑制剂相关性肺炎的预测价值[J]. 中国当代医药, 2022, 29(20): 20-25.
HAN Lihui ； TIAN Hui ； YANG Qiu′an. Predictive value of neutrophil to lymphocyte ratio in immune checkpoint inhibitor-related pneumonitis in lung cancer. 中国当代医药, 2022, 29(20): 20-25.

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https://www.dangdaiyiyao.com/CN/ 或 https://www.dangdaiyiyao.com/CN/Y2022/V29/I20/20

[10]	王慧，夏茸，魏清雯，等.非小细胞肺癌免疫检查点抑制剂相关性肺炎的危险因素及预测生物标志物[J].国际肿瘤学杂志，2021，48（5）：296-301.
[11]	陈秀兰，吴旭，李佳旻，等.肺癌患者免疫检查点抑制剂相关性肺炎的临床分析[J].中国呼吸与危重监护杂志，2021，20（9）：637-642.
[14]	郝捷，李进.中国临床肿瘤学会（CSCO）免疫检查点抑制剂相关的毒性管理指南[M].北京：人民卫生出版社，2021.
[8]	童静植，桂贤华，陈露露，等.不同免疫状态的隐球菌肺炎患者外周血淋巴细胞亚群水平比较[J].临床肺科杂志，2021，26（6）：836-841.
[9]	刘九玉，赵磊，段文超.中性粒细胞/淋巴细胞比值对重症肺炎病情严重程度及预后的评估价值[J].中国医药科学，2021，11（5）：15-18，23.
[1]	Siegel RL，Miller KD，Fuchs HE，et al.Cancer statistics，2022[J].CA Cancer J Clin，2022，72（1）：7-33.
[3]	Iams WT，Porter J，Horn L.Immunotherapeutic approaches for small-cell lung cancer[J].Nat Rev Clin Oncol，2020，17（5）：300-312.
[6]	Yang AP，Liu JP，Tao WQ，et al.The diagnostic and predictive role of NLR，d-NLR and PLR in COVID-19 patients[J].Int Immunopharmacol，2020，84：106504.
[2]	Mok TSK，Wu YL，Kudaba I，et al.Pembrolizumab versus chemotherapy for previously untreated，PD-L1-expressing，locally advanced or metastatic non-small-cell lung cancer（KEYNOTE-042）：a randomised，open-label，controlled，phase 3 trial[J].Lancet，2019，393（10183）：1819-1830.
[4]	Arnaud-Coffin P，Maillet D，Gan HK，et al.A systematic review of adverse events in randomized trials assessing immune checkpoint inhibitors[J].Int J Cancer，2019，145（3）：639-648.
[5]	Wang F，Nie J，Wang H，et al.Characteristics of Peripheral Lymphocyte Subset Alteration in COVID-19 Pneumonia[J].J Infect Dis，2020，221（11）：1762-1769.
[7]	Xie C，Wei B，Li Y.A case-control study on the relationship between the ratio of neutrophils to lymphocytes in malignant tumors and ventilator-associated pneumonia[J].Zhonghua Wei Zhong Bing Ji Jiu Yi Xue，2021，33（2）：165-168.
[12]	Oken MM，Creech RH，Tormey DC，et al.Toxicity and response criteria of the Eastern Cooperative Oncology Group[J].Am J Clin Oncol，1982，5（6）：649-655.
[13]	Amin MB，Greene FL，Edge SB，et al.The Eighth Edition AJCC Cancer Staging Manual：Continuing to build a bridge from a population-based to a more "personalized" approach to cancer staging[J].CA Cancer J Clin，2017，67（2）：93-99.
[15]	王奎，张宏毅，王泽权，等.PD-1和PD-L1抑制剂治疗肺癌及其不良反应的研究现状及进展[J].中国医药科学，2021，11（3）：45-48.
[16]	Kalisz KR，Ramaiya NH，Laukamp KR，et al.Immune Checkpoint Inhibitor Therapy-related Pneumonitis：Patterns and Management[J].Radiographics，2019，39（7）：1923-1937.
[17]	Suzuki Y，Karayama M，Uto T，et al.Assessment of Immune-Related Interstitial Lung Disease in Patients With NSCLC Treated with Immune Checkpoint Inhibitors：A Multicenter Prospective Study[J].J Thorac Oncol，2020，15（8）：1317-1327.
[18]	Hasegawa S，Ikesue H，Nakao S，et al.Analysis of immune-related adverse events caused by immune checkpoint inhibitors using the Japanese Adverse Drug Event Report database[J].Pharmacoepidemiol Drug Saf，2020，29（10）：1279-1294.
[19]	Gomatou G，Tzilas V，Kotteas E，et al.Immune Checkpoint Inhibitor-Related Pneumonitis[J].Respiration，2020，99（11）：932-942.
[20]	Wang DY，Salem JE，Cohen JV，et al.Fatal Toxic Effects Associated With Immune Checkpoint Inhibitors：A Systematic Review and Meta-analysis[J].JAMA Oncol，2018，4（12）：1721-1728.
[21]	Zitvogel L，Tesniere A，Kroemer G.Cancer despite immunosurveillance：immunoselection and immunosubversion[J].Nat Rev Immunol，2006，6（10）：715-727.
[22]	Yu Y，Qian L，Cui J.Value of neutrophil-to-lymphocyte ratio for predicting lung cancer prognosis：A meta-analysis of 7,219 patients[J].Mol Clin Oncol，2017，7（3）：498-506.
[23]	Diem S，Schmid S，Krapf M，et al.Neutrophil-to-Lymphocyte ratio （NLR） and Platelet-to-Lymphocyte ratio （PLR） as prognostic markers in patients with non-small cell lung cancer （NSCLC） treated with nivolumab[J].Lung Cancer，2017，111：176-181.
[24]	Soyano AE，Dholaria B，Marin-Acevedo JA，et al.Peripheral blood biomarkers correlate with outcomes in advanced non-small cell lung Cancer patients treated with anti-PD-1 antibodies[J].J Immunother Cancer，2018，6（1）：129.
[25]	李四香，赵李.中性粒细胞与淋巴细胞比值在慢性阻塞性肺疾病中的应用研究进展[J].中国呼吸与危重监护杂志，2020，19（3）：304-308.
[26]	费明明，童飞，陶小根，等.中性粒细胞/淋巴细胞比值对新型冠状病毒肺炎患者疾病分型的诊断价值[J].中华危重病急救医学，2020，32（5）：554-558.
[27]	程森中，胡波，曹琴，等.中性粒细胞/淋巴细胞比值和纤维蛋白原检测对呼吸机相关性肺炎的诊断价值[J].安徽医药，2020，24（12）：2394-2398.
[28]	Owen DH，Wei L，Bertino EM，et al.Incidence，Risk Factors，and Effect on Survival of Immune-related Adverse Events in Patients With Non-Small-cell Lung Cancer[J].Clin Lung Cancer，2018，19（6）：e893-e900.
[29]	Suresh K，Naidoo J，Zhong Q，et al.The alveolar immune cell landscape is dysregulated in checkpoint inhibitor pneumonitis[J].J Clin Invest，2019，129（10）：4305-4315.