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C-PLAN指数作为免疫检查点抑制剂治疗晚期食管癌预后指标的临床研究

Value of C-PLAN index as a prognostic indicator of advanced esophageal cancer patients treated with immune checkpoint inhibitors

    摘要
  • 摘要:
    目的 评估C反应蛋白(CRP)、体力状况评分(PS)、乳酸脱氢酶(LDH)、白蛋白(ALB)及衍生中性粒细胞与淋巴细胞比值(dNLR)综合(C-PLAN)指数在接受免疫检查点抑制剂(ICI)治疗的晚期食管癌患者中的预后价值。
    方法 收集扬州大学附属医院接受ICI治疗的147例晚期食管癌患者首次免疫治疗前的血液学指标。对CRP、PS、LDH、ALB及dNLR进行评分并相加得到C-PLAN指数。采用卡方检验分析C-PLAN指数与临床病理特征的相关性; 采用Kaplan-Meier生存曲线分析C-PLAN指数对患者总生存期(OS)与无进展生存期(PFS)的影响; 采用单因素和多因素Cox风险比例回归模型分析C-PLAN指数是否为影响预后的独立因素。
    结果 147例晚期食管癌患者根据C-PLAN指数分为低风险组(＜2分, n=46)和高风险组(≥2分, n=101)。C-PLAN指数与年龄、性别、PS评分、吸烟、临床分期、体质量指数、病理类型、治疗策略和是否手术均无相关性(P>0.05)。低风险组PFS和OS优于高风险组, 差异有统计学意义(P＜0.001)。在单因素Cox回归分析中, C-PLAN指数是PFS(P＜0.001)和OS(P=0.002)的影响因素。在多因素Cox分析中, C-PLAN指数是影响PFS(P=0.001)和OS(P=0.006)的独立预后因素。
    结论 C-PLAN指数可以作为预测接受ICI治疗的晚期食管癌患者预后的可靠临床指标。

     

    Abstract:
    Objective To evaluate the prognostic value of C-reactive protein (CRP), performance status (PS), lactate dehydrogenase (LDH), albumin (ALB) and derived neutrophil-to-lymphocyte ratio (dNLR) composite index (C-PLAN) as a prognostic indicator in advanced esophageal cancer patients treated with immune checkpoint inhibitor (ICI).
    Methods Hematologic indexes of 147 patients with advanced esophageal cancer treated by ICI in the Affiliated Hospital of Yangzhou University were collected before the first immunotherapy. CRP, PS, LDH, ALB and dNLR were scored and added to obtain C-PLAN index. Chi-square test was used to analyze the correlation between C-PLAN index and clinicopathological features; Kaplan-Meier survival curve was used to analyze the effects of C-PLAN index on overall survival (OS) and progression-free survival (PFS). Univariate and multifactor Cox proportional regression models were used to analyze whether C-PLAN index could be used as an independent factor affecting prognosis.
    Results A total of 147 patients with advanced esophageal cancer were divided into low-risk group (scored < 2, n=46) and high-risk group (scored ≥2, n=101) according to C-PLAN index. C-PLAN index was not correlated with age, sex, PS score, smoking, clinical stage, body mass index, pathological type, treatment strategy and operation (P>0.05). PFS and OS in the low-risk group were significantly better than those in the high-risk group (P < 0.001). In univariate Cox regression analysis, C-PLAN index was the influencing factor of PFS (P < 0.001) and OS (P=0.002). In multivariate Cox analysis, C-PLAN index was an independent prognostic factor of PFS (P=0.001) and OS (P=0.006).
    Conclusion C-PLAN index can be used as a reliable clinical index to predict the prognosis of patients with advanced esophageal cancer treated by ICI.

     

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