基线血浆d -二聚体和血小板与抗pd -1抗体治疗的IV期非小细胞肺癌患者无进展生存期的关系

IF 4 2区 医学 Q2 ONCOLOGY Translational lung cancer research Pub Date : 2024-11-30 Epub Date: 2024-11-28 DOI:10.21037/tlcr-24-763
Boyue Pang, Jing Wang, Jing Wang, Jiali Zhang, Xiubao Ren, Ying Han
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引用次数: 0

摘要

背景:在过去的研究中,外周血d -二聚体和血小板在非小细胞肺癌(NSCLC)的治疗中显示出预测价值。然而,对于接受程序性细胞死亡蛋白1 (PD-1)抗体治疗的无驱动基因突变的IV期NSCLC患者,预处理d -二聚体和血小板是否可以作为预测疗效和预后的生物标志物尚不清楚。因此,本研究旨在探讨基线d -二聚体和血小板水平与研究人群疗效和预后的相关性,有助于确定基线d -二聚体和血小板水平作为生物标志物的意义。方法:本研究纳入150例新诊断的无驱动基因突变的IV期NSCLC患者,进行回顾性分析。其中一线抗pd -1联合化疗100例,单独化疗50例(2:1)。治疗前收集所有患者的基本资料和临床资料。首先比较两种治疗方案在无进展生存期(PFS)和客观缓解率(ORR)方面的差异。随后分别分析抗pd -1联合化疗组和单独化疗组,将患者分为预处理高、低d -二聚体组,预处理高、低血小板组。采用Kaplan-Meier分析和Cox比例风险模型对PFS数据进行分析。采用卡方检验和logistic回归分析评价治疗效果,特别是ORR差异。所有患者均通过电子病历和电话随访,通过影像学检查进行疾病评估,随访截止日期为2024年5月19日。Kaplan-Meier分析显示,接受抗pd -1联合化疗的患者比单独接受化疗的患者有更长的PFS(中位数,8.5个月对5.5个月;结论:预处理血浆d -二聚体和血小板水平可作为无驱动基因突变接受抗pd -1抗体治疗的IV期非小细胞肺癌患者便捷的预后生物标志物。基线d -二聚体和血小板水平较高的患者可能有较差的PFS。
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Association of baseline plasma D-dimer and platelets with progression-free survival in patients with stage IV non-small cell lung cancer treated with anti-PD-1 antibody.

Background: In past studies, peripheral blood D-dimer and platelets have shown predictive value in the treatment of non-small cell lung cancer (NSCLC). However, it remains unclear whether pretreatment D-dimer and platelets can serve as biomarkers for predicting efficacy and prognosis in stage IV NSCLC patients without driver gene mutations receiving programmed cell death protein 1 (PD-1) antibody. Therefore, this study aims to investigate the correlation between baseline D-dimer and platelet levels and the efficacy and prognosis in the study population, aiding in determining the significance of baseline D-dimer and platelet levels as biomarkers.

Methods: This study included 150 patients who were newly diagnosed with stage IV NSCLC without driver gene mutations and conducted a retrospective analysis. Among them, 100 patients received first-line treatment with anti-PD-1 plus chemotherapy, while 50 patients received chemotherapy alone (2:1). Basic and clinical information for all patients was collected before treatment. Firstly, the differences in progression-free survival (PFS) and objective response rate (ORR) between the two treatment regimens were compared. Subsequently, the anti-PD-1 plus chemotherapy group and chemotherapy-alone group were analyzed separately, dividing patients into pretreatment high and low D-dimer group, as well as pretreatment high and low platelet group. Kaplan-Meier analysis and Cox proportional hazards models were used to analyze PFS data. Chi-squared tests and logistic regression analysis were employed to evaluate treatment efficacy, specifically ORR differences. All patients were followed up through electronic medical records and telephone, and disease assessment was conducted via imaging examinations, with the follow-up deadline being May 19, 2024.

Results: Kaplan-Meier analysis demonstrated that patients receiving anti-PD-1 plus chemotherapy had longer PFS compared to those receiving chemotherapy alone (median, 8.5 versus 5.5 months; P<0.001). Multivariate Cox regression analysis revealed that first-line chemotherapy (P<0.001), high baseline D-dimer level (P=0.002) and platelet count (P=0.04) were independent risk factors for shorter PFS. Pearson's Chi-squared test showed that the ORR was 46.00% for the anti-PD-1 plus chemotherapy group and 14.00% for the chemotherapy group (P<0.001). In the anti-PD-1 plus chemotherapy group, patients with low baseline D-dimer levels had longer PFS compared to those with high D-dimer level (median, 13.0 versus 8.0 months; P=0.005). Similar results were observed for baseline platelet count (median, 9.5 versus 6.5 months; P=0.005). In this group, no statistically significant differences were found in ORR between high and low D-dimer subgroups or high and low platelet subgroups (P=0.51 for D-dimer subgroups, P=0.87 for platelet subgroups). In the chemotherapy group, no correlation was observed between baseline D-dimer or platelet levels and PFS or ORR.

Conclusions: Pretreatment plasma D-dimer and platelet levels could serve as convenient prognostic biomarkers for stage IV NSCLC patients without driver gene mutations receiving anti-PD-1 antibody. Patients with higher baseline D-dimer and platelet levels might have poor PFS.

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来源期刊
CiteScore
7.20
自引率
2.50%
发文量
137
期刊介绍: Translational Lung Cancer Research(TLCR, Transl Lung Cancer Res, Print ISSN 2218-6751; Online ISSN 2226-4477) is an international, peer-reviewed, open-access journal, which was founded in March 2012. TLCR is indexed by PubMed/PubMed Central and the Chemical Abstracts Service (CAS) Databases. It is published quarterly the first year, and published bimonthly since February 2013. It provides practical up-to-date information on prevention, early detection, diagnosis, and treatment of lung cancer. Specific areas of its interest include, but not limited to, multimodality therapy, markers, imaging, tumor biology, pathology, chemoprevention, and technical advances related to lung cancer.
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