吴侃¹;杨邵瑜²;李鑫²;朱鲁程¹;陈雪琴²;马胜林¹

• 1:浙江大学医学院附属杭州市肿瘤医院胸部肿瘤科，浙江大学癌症中心，浙江省临床肿瘤药理与毒理学研究重点实验室，浙江 杭州 310002
• 2:浙江大学医学院附属杭州市第一人民医院胸部肿瘤科，浙江大学癌症中心，浙江省临床肿瘤药理与毒理学研究重点实验室，浙江杭州 310006

摘要(Abstract)：

目的 分析晚期肺癌患者免疫检查点抑制剂治疗疗效，探索临床预测因素。方法 回顾性分析2017年至2020年于浙江大学医学院附属杭州市肿瘤医院接受免疫检查点抑制剂治疗的84例晚期肺癌患者的临床资料，根据免疫治疗实体瘤反应评价标准（immune response evaluation criteria in solid tumor，iRECIST）进行最佳疗效评估，Kaplan-Meier法统计无进展生存期和总生存期。单因素和多因素Cox分险比例回归模型分析预后相关因素。结果 84例晚期肺癌患者中，免疫完全缓解1例，免疫部分缓解25例，免疫疾病稳定34例，免疫疾病进展24例。中位总生存期为25.93个月，中位无进展生存期为6.90个月。多因素Cox回归分析显示，大剂量激素治疗史（ HR=2.518，P=0.004）、二线及以上治疗（ HR=2.394，P=0.003）和高中性粒细胞/淋巴细胞比值（neutrophil to lymphocyte ratio，NLR ； HR=2.682，P=0.001）是晚期肺癌免疫治疗后无进展生存期的独立危险因素。大剂量激素治疗史（ HR=3.216，P=0.002）和高NLR（ HR=4.125，P<0.01）是总生存期的独立危险因素。结论 免疫检查点抑制剂治疗是晚期肺癌一种有效的治疗方式。一线尽早使用免疫检查点抑制剂治疗能够增加生存获益，首次最佳疗效时NLR水平有一定的预后价值，使用大剂量激素与预后不佳有一定的相关性。

关键词(KeyWords)： 肺癌;免疫检查点抑制剂治疗;糖皮质激素;治疗线数;中性粒细胞/淋巴细胞比值

Abstract:

Keywords:

基金项目(Foundation): 浙江省自然科学基金/探索项目Q(LQ20H160019)

作者(Authors): 吴侃¹;杨邵瑜²;李鑫²;朱鲁程¹;陈雪琴²;马胜林¹

DOI: 10.13267/j.cnki.syzlzz.2022.023

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