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非小细胞肺癌患者抗PD-L1治疗前后NK细胞动态变化与治疗反应性的相关性
作者:宋娟丽  王志芬  冀青青  刘峥 
单位:河北省邯郸市中心医院 肿瘤三科, 河北 邯郸 056000
关键词:非小细胞肺癌 免疫治疗 程序性死亡配体-1 自然杀伤细胞 
分类号:R734.2
出版年·卷·期(页码):2023·42·第五期(666-672)
摘要:

目的:探讨非小细胞肺癌(NSCLC)患者抗程序性死亡配体-1(PD-L1)治疗前后自然杀伤(NK)细胞动态变化与治疗反应性的相关性。方法:选择2020年3月至2021年12月于我院确诊的NSCLC患者100例,所有患者分期均为Ⅲ期及以上,不能进行手术切除。在开始抗PD-L1治疗前收集患者资料,并在治疗前及治疗1个疗程时抽取患者静脉血行流式细胞术,对患者两个时间点的辅助T(Th)细胞、细胞毒性T(Tc)细胞、B细胞及NK细胞分化情况进行分析。根据患者治疗反应性将患者分为疾病控制(DC)组和疾病进展(PD)组,采用Logistic回归分析影响治疗反应性的相关因素。结果:最终纳入研究的患者共93例,DC 组67例,PD组26例。DC组患者治疗后中性粒细胞与淋巴细胞比值(NLR)低于PD组,而治疗后NK细胞高于PD组(P<0.05);DC组患者治疗前后NK细胞差值及治疗前后比值均明显低于PD组(U=-1.963、-2.005,P=0.049、0.045)。治疗后NLR、NK治疗前后比值、PD-L1是影响NSCLC患者免疫治疗效果的独立因素(P<0.05)。随着NK细胞治疗前后比值升高,NSCLC患者治疗反应为PD的风险呈升高趋势(非线性=0.376,P=0.099)。结论:NSCLC患者抗PD-L1治疗前后NK细胞动态变化与治疗反应性具有显著相关性。

Objective: To investigate the relationship between the dynamic changes of natural killer(NK) cells and therapeutic responsiveness in patients with non-small cell lung cancer(NSCLC) before and after anti programmed death ligand 1(PD-L1)therapy. Methods: 100 patients with NSCLC diagnosed in our hospital from March 2020 to December 2021 were selected. All patients were in stage Ⅲ or above and could not be resected surgically. The clinical data of patients were collected before the start of anti PD-L1 treatment, and the venous blood of patients was drawn before treatment and during one course of treatment for flow cytometry to analyze the differentiation of helper T(Th) cells, cytotoxic T(Tc) cells, B cells and NK cells at two time points. Patients were divided into disease control(DC) group and disease progression(PD) group according to their response to treatment, and then the related factors affecting the treatment response were analyzed by Logistic regression. Results: A total of 93 patients finally included in the study, 67 cases in DC group and 26 cases in PD group. After treatment, the ratio of neutrophils to lymphocytes(NLR) in DC group was lower than that in PD group, while the NK cells in DC group were higher than that in PD group(P<0.05). The difference and ratio of NK cells before and after treatment in DC group were significantly lower than those in PD group(U=-1.963, -2.005; P=0.049,0.045). After treatment, NLR, NK ratio before and after treatment and PD-L1 were independent factors affecting the immunotherapeutic effect of NSCLC patients(P<0.05). With the increase of NK ratio before and after treatment, the risk of PD response in NSCLC patients increased (nonlinear=0.376,P=0.099). Conclusion: The dynamic changes of NK cells in NSCLC patients before and after anti PD-L1 treatment are significantly correlated with the response to treatment.

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