引用本文:张雅君,张振安,王继华,周 媛,梁凤霞.血清TRAIL水平与晚期非小细胞肺癌患者免疫治疗反应的关联性研究[J].中国临床新医学,2024,17(6):645-650.
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血清TRAIL水平与晚期非小细胞肺癌患者免疫治疗反应的关联性研究
张雅君1,张振安1,王继华2,周 媛1,梁凤霞1
1.唐山市人民医院呼吸与危重症医学科,河北 063000;2.唐山市人民医院中西医结合肿瘤科,河北 063000
摘要:
[摘要] 目的 探讨血清肿瘤坏死因子相关凋亡诱导配体(TRAIL)水平与晚期非小细胞肺癌(NSCLC)患者免疫治疗反应的关联性。方法 回顾性分析2019年1月至2020年5月唐山市人民医院收治的70例晚期NSCLC患者的临床资料。在免疫治疗前24 h内采用酶联免疫吸附试验法(ELISA)测定患者血清TRAIL水平。免疫治疗反应通过客观缓解率(ORR)和临床获益率(CBR)进行评估。分析患者血清TRAIL水平与免疫治疗反应、肺功能及肺气肿、临床预后的关联性。结果 经免疫治疗后,NSCLC患者获得客观缓解23例,临床获益46例。获得客观缓解患者的血清TRAIL水平显著高于未获得客观缓解者[27.77(23.13,39.13)pg/mL vs 12.36(8.76,18.15)pg/mL;Z=4.508,P<0.001]。临床获益患者的血清TRAIL水平显著高于临床未获益者[23.13(16.99,30.63)pg/mL vs 11.75(8.76,15.56)pg/mL;Z=4.887,P<0.001]。Spearman秩相关性分析结果显示,血清TRAIL水平与1秒用力呼气容积/用力肺活量(FEV1/FVC)呈正相关(rs=0.288,P=0.016),与肺气肿总比值(rs=-0.257,P=0.032)、肺叶肺气肿比率(LER)(rs=-0.324,P=0.006)呈负相关。多因素logistic回归分析结果显示,以血清TRAIL>27.46 pg/mL为参考,血清TRAIL<18.15 pg/mL患者经免疫治疗不能获得客观缓解和临床获益的风险显著增加(P<0.05)。ROC曲线分析结果显示,血清TRAIL水平可有效预测NSCLC患者对免疫治疗的反应(P<0.05)。TRAIL高水平组(血清TRAIL≥18.15 pg/mL)的总体生存(OS)、无进展生存(PFS)预后显著优于TRAIL低水平组(血清TRAIL<18.15 pg/mL)(P<0.05)。结论 血清TRAIL低水平与晚期NSCLC患者免疫治疗无反应以及临床预后不良有关,该指标监测有助于筛选能从免疫治疗中获益的NSCLC患者。
关键词:  肿瘤坏死因子相关凋亡诱导配体  晚期非小细胞肺癌  免疫治疗反应  肺气肿  预后
DOI:10.3969/j.issn.1674-3806.2024.06.10
分类号:R 734.2
基金项目:河北省自然科学基金项目(编号:20201112)
A study on the relationship between serum TRAIL level and immunotherapy response in patients with advanced non-small cell lung cancer
ZHANG Yajun1, ZHANG Zhen′an1, WANG Jihua2, ZHOU Yuan1, LIANG Fengxia1
1.Department of Respiratory and Critical Care Medicine, Tangshan People′s Hospital, Hebei 063000, China; 2.Department of Traditional Chinese and Western Medicine Oncology, Tangshan People′s Hospital, Hebei 063000, China
Abstract:
[Abstract] Objective To explore the relationship between serum tumor necrosis factor-related apoptosis-inducing ligand(TRAIL) level and immunotherapy response in patients with advanced non-small cell lung cancer(NSCLC). Methods The clinical data of 70 patients with advanced NSCLC who were admitted to Tangshan People′s Hospital from January 2019 to May 2020 were retrospectively analyzed. The serum TRAIL level was determined by using enzyme-linked immunosorbent assay(ELISA) within 24 hours before immunotherapy. Immunotherapy response was assessed by using objective response rate(ORR) and clinical benefit rate(CBR). The relationship of the patients′ serum TRAIL levels with immunotherapy response, lung function, emphysema and clinical prognosis was analyzed. Results After immunotherapy, 23 patients with NSCLC achieved objective remission and 46 patients achieved clinical benefit. The serum TRAIL level in patients with objective remission was significantly higher than that in patients without objective remission[27.77(23.13, 39.13)pg/mL vs 12.36(8.76, 18.15)pg/mL; Z=-4.508, P<0.001]. The serum TRAIL level in patients with clinical benefit was significantly higher than that in patients without clinical benefit[23.13(16.99, 30.63)pg/mL vs 11.75(8.76, 15.56)pg/mL; Z=-4.887, P<0.001]. The results of Spearman rank correlation analysis showed that serum TRAIL level was positively correlated with forced expiratory volume in 1 second(FEV1)/forced vital capacity(FVC)(rs=0.288, P=0.016), and negatively correlated with total emphysema ratio(rs=-0.257, P=0.032) and lobar emphysema rate(LER)(rs=-0.324, P=0.006). The results of multivariate logistic regression analysis showed that taking serum TRAIL level >27.46 pg/mL as a reference, patients with serum TRAIL level <18.15 pg/mL had a significantly increased risk of not achieving objective remission and clinical benefit after immunotherapy(P<0.05). The results of receiver operating characteristic(ROC) curve analysis showed that serum TRAIL level could effectively predict the response of NSCLC patients to immunotherapy(P<0.05). The overall survival(OS) and progression-free survival(PFS) prognoses of the high TRAIL level group(serum TRAIL≥18.15 pg/mL) were significantly better than those of the low TRAIL level group(serum TRAIL<18.15 pg/mL)(P<0.05). Conclusion Low serum TRAIL level is associated with non-response to immunotherapy and poor clinical prognosis in advanced NSCLC patients, and monitoring this indicator helps to screen NSCLC patients who can benefit from immunotherapy.
Key words:  Tumor necrosis factor-related apoptosis-inducing ligand(TRAIL)  Advanced non-small cell lung cancer  Immunotherapy response  Emphysema  Prognosis