国际肿瘤学杂志

国际肿瘤学杂志 ›› 2022, Vol. 49 ›› Issue (5): 270-275.doi: 10.3760/cma.j.cn371439-20211123-00050

• 论著 • 上一篇    下一篇

组织TSR值对NSCLC免疫治疗疗效的预测价值

肖梦霞1, 姚颐1,2(), 高利昆3, 宋启斌1,2()   

  1. 1武汉大学人民医院肿瘤中心,武汉 430060
    2湖北省肿瘤精准医学研究中心,武汉 430200
    3武汉大学人民医院病理科,武汉 430060
  • 收稿日期:2021-11-23 修回日期:2022-03-13 出版日期:2022-05-08 发布日期:2022-05-31
  • 通讯作者: 姚颐,宋启斌,孙娜 E-mail:yaoyi2018@whu.edu.cn;qibinsong@whu.edu.cn

Predictive value of tissue TSR for the efficacy of immunotherapy in non-small lung cancer

Xiao Mengxia1, Yao Yi1,2(), Gao Likun3, Song Qibin1,2()   

  1. 1Cancer Center, Renmin Hospital of Wuhan University, Wuhan 430060, China
    2Hubei Provincial Research Center for Precision Medicine of Cancer, Wuhan 430200, China
    3Department of Pathology, Renmin Hospital of Wuhan University, Wuhan 430060, China
  • Received:2021-11-23 Revised:2022-03-13 Online:2022-05-08 Published:2022-05-31
  • Contact: Yao Yi,Song Qibin E-mail:yaoyi2018@whu.edu.cn;qibinsong@whu.edu.cn

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摘要：

目的 探索非小细胞肺癌（NSCLC）组织中肿瘤间质比（TSR）对肿瘤免疫治疗疗效预测的价值。方法 收集2017年1月至2020年12月期间武汉大学人民医院接受免疫检查点抑制剂治疗的ⅢB~Ⅳ期NSCLC患者的临床和组织病理学资料,以50%为TSR界值,将患者分为低TSR组（≤50%）和高TSR组（>50%）,比较两组临床病理特征、4周期客观缓解率（ORR）和疾病控制率（DCR）、6周期ORR和DCR以及无进展生存期（PFS）的差异,采用单因素及多因素Cox回归模型分析与PFS相关的预后因素。结果 共纳入患者50例,其中低TSR组27例,高TSR组23例。两组年龄（χ2=0.59,P=0.441）、性别（P=0.578）、吸烟史（χ2=0.12,P=0.730）、组织类型（χ2=2.33,P=0.313）、TNM分期（χ2=0.22,P=0.636）、4周期ORR（χ2=0.48,P=0.487）和DCR（P=0.593）、6周期ORR（χ2=0.05,P=0.818）和DCR（P=0.641）差异均无统计学意义;高TSR组较低TSR组脑转移发生率更高[34.8%（8/23） vs. 7.4%（2/27）,χ2=4.23,P=0.040]。Kaplan-Meier生存分析显示,与高TSR组相比,低TSR组的PFS明显更长（15.6个月 vs. 10.2个月,χ2=13.84,P<0.001）。单因素分析结果显示TSR值（HR=0.29,95%CI为0.14~0.58,P<0.001）、脑转移（HR=2.38,95%CI为1.12~5.05,P=0.024）均与NSCLC患者更差的预后存在相关性。多因素Cox回归分析显示TSR值是影响NSCLC免疫治疗的独立预后因素（HR=0.32,95%CI为0.14~0.70,P=0.004）。结论 TSR是NSCLC免疫治疗的独立预后因素,但是否可预测晚期NSCLC免疫治疗的近期疗效仍需进一步研究。

关键词: 癌,非小细胞肺, 肿瘤间质比, 免疫疗法, 疗效, 预后

Abstract:

Objective To explore the value of tumor stroma ratio （TSR） in non-small lung cancer （NSCLC） tissue in predicting the efficacy of tumor immunotherapy. Methods The clinical and histopathological data of patients with stage ⅢB-Ⅳ NSCLC treated with immune checkpoint inhibitors in the Renmin Hospital of Wuhan University from January 2017 to December 2020 were collected. Taking 50% as the TSR boundary value, the patients were divided into low TSR group （≤50%） and high TSR group （>50%）. The histopathological features, 4-cycle objective response rate （ORR） and disease control rate （DCR）, 6-cycle ORR and DCR, and progression-free survival （PFS） were compared between the two groups. Univariate and multivariate Cox regression models were used to analyze the prognostic factors related to PFS. Results A total of 50 patients were included, including 27 with low TSR and 23 with high TSR. There were no significant differences between the two groups in age （χ2=0.59, P=0.441）, gender （P=0.578）, smoking history （χ2=0.12, P=0.730）, histopathological type （χ2=2.33, P=0.313）, TNM stage （χ2=0.22, P=0.636）, 4-cycle ORR （χ2=0.48, P=0.487） and DCR （P=0.593）, 6-cycle ORR （χ2=0.05, P=0.818） and DCR （P=0.641）. The incidence of brain metastasis was higher in the high TSR group than that in the low TSR group [34.8% （8/23） vs. 7.4%（2/27）, χ2=4.23, P=0.040]. Kaplan-Meier survival analysis showed that the PFS in the low TSR group was significantly longer than that in the high TSR group （15.6 months vs. 10.2 months, χ2=13.84, P<0.001）. Univariate analysis showed that TSR value （HR=0.29, 95%CI： 0.14-0.58, P<0.001） and brain metastasis （HR=2.38, 95%CI： 1.12-5.05, P=0.024） were correlated with the worse prognosis of NSCLC patients. Multivariate Cox regression analysis showed that TSR value was an independent prognostic factor for NSCLC immunotherapy （HR=0.32, 95%CI： 0.14-0.70, P=0.004）. Conclusion TSR is an independent predictor of immunotherapy for NSCLC, but whether it can predict the short-term efficacy of immunotherapy for advanced NSCLC still needs further research.

Key words: Carcinoma, non-small-cell lung, Tumor stroma ratio, Immunotherapy, Curative effect, Prognosis