外周血PD-L1分子表达联合LDH对晚期非小细胞肺癌免疫治疗效果的预测价值

Predictive value of peripheral blood PD-L1 combined with LDH for the efficacy of immunotherapy in advanced non-small cell lung cancer

摘要:

目的 探讨外周血程序性死亡配体1（PD-L1）分子表达联合乳酸脱氢酶（LDH）对晚期非小细胞肺癌（NSCLC）免疫治疗效果的预测价值。方法 回顾性分析2018年1月—2021年8月马鞍山市人民医院收治的88例晚期NSCLC免疫治疗患者的临床资料。治疗3个疗程后根据疗效分为无效组和有效组。采用单因素分析影响晚期NSCLC免疫治疗无效的因素，对影响晚期NSCLC免疫治疗无效的因素进行多因素一般Logistic回归分析，绘制受试者工作特征（ROC）曲线分析外周血PD-L1分子表达联合LDH水平预测晚期NSCLC免疫治疗效果的价值。结果 无效组患者低分化构成比、PD-L1、LDH高于有效组患者（P <0.05）。一般多因素Logistic回归分析结果显示，分化程度［O^R=3.114（95% CI：1.281，7.569）］、PD-L1［O^R=3.951（95% CI：1.583，9.860）］、LDH［O^R=3.432（95% CI：1.375，8.564）］是导致晚期NSCLC免疫治疗无效的危险因素（P <0.05）。ROC曲线分析结果显示，PD-L1敏感性最高，为82.98%；PD-L1和LDH联合诊断的特异性最高，为97.56%；联合诊断的曲线下面积最高，为0.934。结论 外周血PD-L1分子表达联合LDH水平用于预测晚期NSCLC免疫治疗效果具有重要价值。

Abstract:

Objective To explore the predictive value of peripheral blood programmed death ligand 1 (PD-L1) combined with lactate dehydrogenase (LDH) for the efficacy of immunotherapy in advanced non-small cell lung cancer.Methods The data of 88 patients with advanced non-small cell lung cancer undergoing immunotherapy admitted to our hospital from January 2018 to August 2021 were retrospectively analyzed. After three courses of treatment, they were divided into ineffective group and effective group according to the therapeutic efficacy. The univariable analysis was performed to determine the factors that affect the efficacy of immunotherapy for advanced non-small cell lung cancer, and multivariable Logistic regression analysis was further performed to determine the independent risk factors for the ineffectiveness of immunotherapy. The receiver operating characteristic (ROC) curve was used to analyze the value of peripheral blood PD-L1 and LDH levels for predicting the ineffectiveness of immunotherapy for advanced non-small cell lung cancer.Results The proportion of poor differentiation and the levels of PD-L1 and LDH in the ineffective group were higher than those in the effective group (P < 0.05). The multivariable Logistic regression analysis showed that the degree of differentiation [O^R = 3.114 (95% CI: 1.281, 7.569)], PD-L1 level [O^R=3.951 (95% CI: 1.583, 9.860) ], and LDH level [O^R = 3.432 (95% CI: 1.375, 8.564)] were risk factors for the ineffectiveness of immunotherapy for advanced non-small cell lung cancer (P < 0.05). The ROC curve analysis revealed that the sensitivity of PD-L1 was the highest (82.98%) for predicting the ineffectiveness of immunotherapy for advanced non-small cell lung cancer. In contrast, the specificity of the combined detection of PD-L1 and LDH was the highest (97.56%), and the area under the ROC curve of the combined detection of PD-L1 and LDH was also the greatest (0.934).Conclusions Peripheral blood PD-L1 expression combined with LDH level is of great value for predicting the efficacy of immunotherapy for advanced non-small cell lung cancer.