PET/CT定量参数联合血液学指标对免疫检查点抑制剂联合化疗治疗晚期肺癌患者预后的预测价值

目的 分析 18F-脱氧葡萄糖（18F-FDG）正电子发射体层成像（PET）/CT定量参数联合血液学指标对免疫检查点抑制剂（ICIs）联合化疗治疗晚期肺癌患者预后的预测价值。方法 回顾性收集确诊晚期肺癌患者共118例，均接受帕博利珠单抗注射液联合常规化疗，至少连续进行4个周期（21 d为1个周期），根据实体肿瘤的免疫反应评价标准（iRECIST）评估临床疗效，分为应答组70例和无应答组48例。治疗前采用PET/CT检测固定标准化摄取值（SUV）max、SUVmean和SUVpeak，总肿瘤体积（MTV）和总病变糖酵解（TLG），以及全身负荷值MTVwb、TLGwb、SUVmeanwb和SUVmaxwb；检测血清中性粒细胞计数、淋巴细胞计数、白蛋白，计算中性粒细胞与淋巴细胞比值（NLR）。比较应答组和无应答组 PET/CT 参数和血液学检查结果的差异，多因素 Logistic 回归分析影响患者无应答的危险因素。Kaplan-Meier法绘制生存曲线，比较累积生存率的差异。结果 与无应答组相比，应答组SUVmax、MTV、MTVwb和NLR值均显著降低，差异有统计学意义（P＜0.05）。多因素Logistic回归分析显示，SUVmax≥11.28和NLR≥5.97是无应答的危险因素（P＜0.05）。随访时间6~30个月，118例患者存活69例（58.5%）。Kaplan-Meier生存曲线显示，高风险组（SUVmax≥11.28和NLR≥5.97）较中风险组（SUVmax≥11.28或NLR≥5.97）和低风险组（SUVmax＜11.28和NLR＜5.97）的累积生存率显著降低（P＜0.01）。结论 18F-FDG PET/CT检测SUVmax值与血清NLR值对预测ICIs联合化疗治疗晚期肺癌的临床疗效与短期预后有较好的应用价值。

Predictive value of prognosis of quantitative parameters of PET/CT combined with#br#hematological indexes for patients with advanced lung cancer treated with#br#immune checkpoint inhibitors combined with chemotherapy #br#

Objective To analyze the predictive value of quantitative parameters of PET/CT combined withhematological indexes for the prognosis in patients with advanced lung cancer treated by immune checkpoint inhibitor (ICI)combined with chemotherapy. Methods A total of 118 patients with advanced lung cancer admitted to our hospital wereretrospectively included in this study. All patients received pembrolizumab injection combined with conventionalchemotherapy for at least four consecutive periods (21 days as one period). The clinical efficacy was evaluated according toiRECIST criteria. Patients were divided into the clinical response group (n=70) and the non-response group (n=48). 18F-FDGpositron emission tomography (PET) / CT was used to detect fixed standard uptake (SUV) max, SUVmean and SUVpeak, totaltumor volume (MTV), total lesion glycolysis (TLG), and systemic load (MTVwb, TLGwb, SUVmeanwb and SUVmaxwb) beforetreatment. Data of neutrophil count, platelet count, albumin and neutrophil-lymphocyte ratio (NLR) were measured. PET/CTparameters and hematology results were compared between the two groups. Multivariate Logistic regression analysis wasperformed to analyze the risk factors influencing non-response in patients. Kaplan-Meier method was used to draw survivalcurves and the differences in cumulative survival rates were compared. Results Compared with the non-response group, SUVmax, MTV, MTVwb and NLR were significantly decreased in the response group (P＜0.05). Multivariate Logisticregression analysis showed that SUVmax ≥ 11.28 and NLR ≥ 5.97 were risk factors to the non-response (P＜0.05). Themedian follow-up time was 22.5 months (range, 6-30 months) and 69 patients survived (58.5%，69/118). Multivariate Coxregression analysis showed that SUVmax ≥11.28 and NLR ≥5.97 were closely related to OS (P＜0.05). Kaplan-Meiersurvival curve showed that cumulative survival rate was significantly lower in the high-risk group (SUVmax ≥11.28 andNLR ≥5.97) than that in the medium-risk group (SUVmax ≥11.28 or NLR ≥5.97) and the low-risk group (SUVmax ＜11.28and NLR ＜5.97) (P＜0.01). Conclusion SUVmax value and serum NLR value detected by 18F-FDG PET/CT has goodapplication value in predicting clinical efficacy and short-term prognosis in advanced lung cancer by ICI combined withchemotherapy.