| 基线总胆红素水平对晚期非小细胞肺癌免疫治疗疗效的预测价值 |
| 投稿时间：2024-11-25 修订日期：2024-12-10 点此下载全文 |
| 引用本文：麻利杰,朱皖玲,陈昊,张译升,张晓娇,赵力.基线总胆红素水平对晚期非小细胞肺癌免疫治疗疗效的预测价值[J].医学研究杂志,2025,54(5):136-140, 173 |
| DOI：
10.11969/j.issn.1673-548X.2025.05.025 |
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| 基金项目:江苏省徐州市科技计划项目(KC20063) |
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| 中文摘要:目的 探讨外周血基线总胆红素(total bilirubin, TBIL)水平与晚期非小细胞肺癌(non-small cell lung cancer, NSCLC)免疫治疗的疗效预后和免疫炎症的相关性。方法 回顾性分析2019年6月～2022年6月接受免疫治疗的晚期NSCLC患者246例,收集患者治疗前血清TBIL指标,根据“X-tile”软件和ROC曲线确定TBIL最佳截断值,分析治疗前TBIL对晚期NSCLC短期疗效和长远预后的影响。结果 通过“X-tile”软件和ROC曲线确定TBIL最佳截断值为10.5μmol/L,短期疗效分析表明TBIL水平较高的患者客观缓解率(objective response rate,ORR)显著高于低水平组(51.3% vs 33.8%,P=0.006)； 高TBIL水平组患者疾病控制率(disease control rate,DCR)较低TBIL水平组更高(92.9% vs 81.2%,P=0.007)。Kaplan-Meier生存分析显示,高TBIL水平组患者中位无进展生存期(progression-free survival, PFS)高于低TBIL水平组(13.0个月 vs 7.0个月,P<0.001),高TBIL水平组患者中位总生存时间(overall survival, OS)高于低TBIL水平组(16.0个月vs 12.0个月,P<0.001)；不同水平胆红素之间的中性粒细胞与淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)、血小板与淋巴细胞比值(platelet-to-lymphocyte ratio,PLR)及系统性免疫炎症指数(systemic immune-inflammation index,SII)比较,差异有统计学意义(P<0.05)。结论 晚期NSCLC的免疫治疗中,较高的基线TBIL水平对患者免疫治疗的疗效和预后呈正相关,TBIL可以作为预测晚期NSCLC患者免疫治疗的重要预测标志物。 |
| 中文关键词:免疫治疗 非小细胞肺癌 疗效 总胆红素 |
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| Predictive Value of Baseline Total Bilirubin Levels on the Efficacy of Immunotherapy in Advanced Non-Small Cell Lung Cancer. |
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| Abstract:Objective To investigate the correlation between peripheral blood total bilirubin (TBIL) levels and the efficacy and prognosis of immunotherapy in advanced non-small cell lung cancer (NSCLC), as well as its relationship with immune inflammation. Methods A retrospective analysis was conducted on 246 patients with advanced NSCLC who received immunotherapy from June 2019 to June 2022. Pre-treatment TBIL levels were collected, and the optimal cutoff value for TBIL was determined using the "X-tile" software and the ROC curve. The impact of pre-treatment TBIL on the short-term efficacy and long-term prognosis of advanced NSCLC was analyzed. Results The optimal cutoff value for TBIL was identified as 10.5μmol/L using the "X-tile" software and the ROC curve. Analysis of short-term efficacy indicated that patients with higher TBIL levels had a significantly better objective response rate (ORR) compared to those with lower levels (51.3% vs 33.8%, P=0.006). The disease control rate (DCR) was also higher in the higher TBIL level group compared to the low level group (92.9% vs 81.2%, P=0.007). Kaplan-Meier survival analysis revealed that patients with elevated TBIL levels had a longer median progression-free survival (PFS) compared to those with lower TBIL levels, with 13.0 vs 7.0 months, respectively (P<0.001). Similarly, the median overall survival (OS) was greater in the higher TBIL level group than in the lower TBIL level group, with 16.0 vs 12.0months, respectively (P<0.001). Additionally, there were significant differences in neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) between two groups of different TBIL levels (P<0.05). Conclusion In immunotherapy for advanced non-small cell lung cancer, patients with higher baseline levels of TBIL exhibit a positive correlation with the efficacy and prognosis of immunotherapy. TBIL might be served as an important predictive marker for immunotherapy in patients with advanced NSCLC. |
| keywords:Immunotherapy Non-small cell lung cancer Efficacy Total bilirubin |
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