LIPI评分对PD-1/PD-L1抑制剂治疗非小细胞肺癌效果与预后的价值分析

Analysis of relationship between LIPI scoring system and PD-1/ PD-L1 inhibitor efficacy and prognosis in patients with non-small cell lung cancer

摘要:

目的 探讨肺癌免疫治疗预后指数（LIPI）对程序性死亡受体1（PD-1）及程序性死亡受体1配体（PD-L1）抑制剂治疗非小细胞肺癌（NSCLC）的预测价值。方法 选取2020年4月—2021年4月山东第一医科大学第三附属医院肿瘤内科收治的180例NSCLC患者。根据LIPI评分分为良好组、中等组、较差组，分别有56、82和46例。患者均接受PD-1/PD-L1抑制剂单一治疗或联合含铂双药化疗方案。比较各组肿瘤疗效、免疫组织化学指标［磷脂酰肌醇3-激酶（PI3K）、蛋白激酶B（PKB）、哺乳动物雷帕霉素靶蛋白（mTOR）］、血清指标［NK细胞活化性受体（NKG2D）、γ干扰素（IFN-γ）、白细胞介素-6（IL-6）］、肺癌生存质量测定量表（FACT-L）、预后［无进展生存期（PFS）、总生存期（OS）、6个月生存率、1年生存率］，采用Kaplan-Meier法进行生存分析。结果 良好组、中等组ORR高于较差组。较差组治疗前后PI3K、PKB、mTOR的差值高于良好组、中等组，良好组低于中等组。较差组治疗前后NKG2D的差值低于良好组、中等组，治疗前后IFN-γ、IL-6的差值高于良好组、中等组，中等组治疗前后NKG2D的差值低于良好组，治疗前后IFN-γ、IL-6的差值高于良好组。较差组治疗前后FACT-L评分的差值低于良好组、中等组，中等组低于良好组。较差组PFS、OS短于良好组、中等组，中等组短于良好组。结论 LIPI评分可用于评估PD-1/PD-L1抑制剂治疗NSCLC患者的效果与预后，LIPI评分高的患者在治疗中获益更高、预后更好。

Abstract:

Objective To analyze the predictive value of Lung Immune Prognostic Index (LIPI) score for the efficacy of programmed death receptor 1 (PD-1)/programmed cell death-ligand 1 (PD-L1) inhibitors in treating non-small cell lung cancer.Methods Prospectively, 180 patients with non-small cell lung cancer (NSCLC) admitted to the Department of Oncology of the Third Affiliated Hospital of Shandong First Medical University were selected, and were divided into good, moderate and poor groups according to the LIPI score, with 56, 82 and 46 cases in each group, respectively. All patients received PD-1/PD-L1 inhibitors as monotherapy or in combination with platinum-based chemotherapy. The oncological efficacy, immunohistochemical indicators [phosphoinositide 3-kinase (PI3K), protein kinase B (PKB), and mammalian target of rapamycin (mTOR) ], serum indicators [natural killer group 2, member D (NKG2D), interferon-γ (IFN-γ) and interleukin-6 (IL-6) ], Function Assessment of Cancer Therapy-Lung (FACT-L) scores, and prognosis [progression free survival (PFS), overall survival (OS), 6-month survival rate, and 1-year survival rate] were compared among the groups. The relationship between the LIPI score and the 1-year survival rate of NSCLC patients was determined via Kaplan-Meier survival analysis.Results The ORR of the good and moderate groups was higher than that of the poor group (P < 0.05). The differences of the levels of PI3K, PKB, and mTOR before and after the treatment were higher in the poor group than those in the other two groups, while those in the good group were lower than those in the moderate group (P < 0.05). Compared with the good and moderate groups, the difference of the level of NKG2D before and after the treatment was lower, but the differences of IFN-γ and IL-6 before and after the treatment were higher in the poor group (P < 0.05). Compared with the good group, the difference of the level of NKG2D before and after the treatment was lower, but the differences of IFN-γ and IL-6 before and after the treatment were higher in the moderate group (P < 0.05). The differences of FACT-L scores of all dimensions before and after the treatment in the poor group were lower than those in the good and moderate groups, while those in the moderate group were even lower than those in the good group (P < 0.05). The PFS and OS in the poor group were lower than those in the other groups, while those in the moderate group were lower than those in the good group (P < 0.05).Conclusions The LIPI scoring system can be used to evaluate the efficacy of PD-1/PD-L1 inhibitors in the treatment of non-small cell lung cancer and the prognosis of patients, where those with high LIPI scores benefit more from the treatment and have a better prognosis.