CHINESE JOURNAL OF MEDICINAL GUIDE >
The Predictive Value of Previous PTV and Inflammatory Markers for the Prognosis of Stage Ⅳ Non-Squamous NSCLC Treated with Camrelizumab Combined with Chemotherapy
Received date: 2024-11-14
Revised date: 2025-09-24
Accepted date: 2025-12-03
Online published: 2025-12-17
Objective： To investigate the predictive value of previous planning target volume （PTV） and inflammatory markers for the prognosis of stage Ⅳ non-squamous non-small cell lung cancer （NSCLC） treated with camrelizumab combined with chemotherapy.Methods： A retrospective analysis was conducted on the clinical data of 84 patients with stage Ⅳ non-squamous NSCLC admitted to the Affiliated Hospital of Weifang Medical University from May 2020 to June 2021. After excluding 4 cases lost to follow-up， 80 patients were ultimately included in the study. All patients had previously received thoracic radiotherapy and experienced disease progression before undergoing camrelizumab combined with chemotherapy. The previous PTV data was collected， and blood routine tests within 7 days before the treatment regimen were used to calculate the monocyte-to-lymphocyte ratio （MLR） and platelet-to-lymphocyte ratio （PLR）. Receiver operating characteristic （ROC） curve analysis was applied to determine the area under the curve （AUC） for each indicator， and the optimal cutoff value for PTV was identified using the ROC curve. The 80 patients were divided into the PTV < 599.95 ccm group and the PTV ≥ 599.95 ccm group. Progression-free survival （PFS）， objective response rate （ORR）， disease control rate （DCR）， and adverse reactions were compared between the two groups. The Kaplan-Meier method was used to calculate survival rates， and the Log-rank test was applied for comparison. Multivariate analysis was performed using the Cox proportional hazards model. P < 0.05 indicates that the difference is statistically significant.Results： The median PFS （mPFS） was significantly longer in the PTV < 599.95 ccm group than in the PTV ≥ 599.95 ccm group （P < 0.05）. There were no statistically significant differences in ORR and DCR between the PTV < 599.95 ccm group and the PTV ≥ 599.95 ccm group （P > 0.05）. The MLR and PLR levels in the PTV < 599.95 ccm group were lower than those in the PTV ≥ 599.95 ccm group （P < 0.05）. Both univariate and multivariate analysis results indicated that PTV < 599.95 ccm was a protective factor for improved PFS （P < 0.05）， while MLR ≥ 0.30 and PLR ≥ 142.70 were risk factors affecting PFS （P < 0.05）. PTV， MLR， and PLR all demonstrated high predictive value for PFS in stage Ⅳ non-squamous NSCLC patients treated with camrelizumab combined with chemotherapy， with combined detection showing even higher predictive value. There was no statistically significant difference in the incidence of adverse reactions between the two groups （P > 0.05）.Conclusion： Previous PTV and inflammatory markers have high application value in predicting the prognosis of camrelizumab combined with chemotherapy in stage Ⅳ non-squamous NSCLC patients， and combined detection offering greater value. Previous PTV < 599.95 cm is an independent protective factor for improved PFS in these patients， but it is not associated with ORR， DCR， or the incidence of adverse reactions.
Shuai Wang
.
The Predictive Value of Previous PTV and
Inflammatory Markers for the Prognosis of Stage Ⅳ Non-Squamous
NSCLC Treated with Camrelizumab Combined with Chemotherapy
［1］ Drilon A， Oxnard GR， Tan DSW， et al. Efficacy of selpercatinib in RET fusion-positive non-small-cell lung cancer［J］.N Engl J Med， 2020，383（9）：813-824.
［2］ Patel SA， Weiss J. Advances in the treatment of non-small cell lung cancer： immunotherapy［J］.Clin Chest Med， 2020，41（2）：237-247.
［3］ Mansfield AS， Murphy SJ， Peikert T， et al. Heterogeneity of programmed cell death ligand 1 expression in multifocal lung cancer［J］.Clin Cancer Res， 2016，22（9）：2177-2182.
［4］ Patel SP， Kurzrock R. PD-L1 expression as a predictive biomarker in cancer immunotherapy［J］.Mol Cancer Ther， 2015，14（4）：847-856.
［5］ Reinert CP， Gatidis S， Sekler J， et al. Clinical and prognostic value of tumor volumetric parameters in melanoma patients undergoing （18）F-FDG-PET/CT： a comparison with serologic markers of tumor burden and inflammation［J］.Cancer Imaging， 2020，20（1）：44.
［6］ Xiong S， Dong L， Cheng L. Neutrophils in cancer carcinogenesis and metastasis［J］.J Hematol Oncol， 2021，14（1）：173.
［7］ Chen C， Yang H， Cai D， et al. Preoperative peripheral blood neutrophil-to-lymphocyte ratios （NLR） and platelet-to-lymphocyte ratio （PLR） related nomograms predict the survival of patients with limited-stage small-cell lung cancer［J］.Transl Lung Cancer Res， 2021，10（2）：866-877.
［8］ Shi M， Zhao W， Zhou F， et al. Neutrophil or platelet-to-lymphocyte ratios in blood are associated with poor prognosis of pulmonary large cell neuroendocrine carcinoma［J］.Transl Lung Cancer Res， 2020，9（1）：45-54.
［9］ Zheng L， Xiong A， Wang S， et al. Decreased monocyte-to-lymphocyte ratio was associated with satisfied outcomes of first-line PD-1 inhibitors plus chemotherapy in stage ⅢB-Ⅳ non-small cell lung cancer［J］.Front Immunol， 2023，14：1094378.
［10］ Werner-Wasik M， Swann RS， Bradley J， et al. Increasing tumor volume is predictive of poor overall and progression-free survival： secondary analysis of the Radiation Therapy Oncology Group 93-11 phase Ⅰ-Ⅱ radiation dose-escalation study in patients with inoperable non-small-cell lung cancer［J］.Int J Radiat Oncol Biol Phys， 2008，70（2）：385-390.
［11］ Karin M， Taugner J， Käsmann L， et al. Association of planning target volume with patient outcome in inoperable stage Ⅲ NSCLC treated with chemoradiotherapy： a comprehensive single-center analysis［J］.Cancers （Basel）， 2020，12（10）：3035.
［12］ Bradley JD， Hu C， Komaki RR， et al. Long-term results of NRG oncology RTOG 0617： standard-versus high-dose chemoradiotherapy with or without cetuximab for unresectable stage Ⅲ non-small-cell lung cancer［J］.J Clin Oncol， 2020，38（7）：706-714.
［13］ Taugner J， Käsmann L， Karin M， et al. Planning target volume as a predictor of disease progression in inoperable stage Ⅲ non-small cell lung cancer patients treated with chemoradiotherapy and concurrent and/or sequential immune checkpoint inhibition［J］.Invest New Drugs， 2022，40（1）：163-171.
［14］ Dall'Olio FG， Marabelle A， Caramella C， et al. Tumour burden and efficacy of immune-checkpoint inhibitors［J］.Nat Rev Clin Oncol， 2022，19（2）：75-90.
［15］ Sugiura A， Rathmell JC. Metabolic barriers to T cell function in tumors［J］.J Immunol， 2018，200（2）：400-407.
［16］ Zang W， Wang G， Xu ZG， et al. Lactate is a natural suppressor of RLR signaling by targeting MAVS［J］.Cell， 2019，178（1）：176-189.
［17］ Abu-Shawer O， Abu-Shawer M， Hirmas N， et al. Hematologic markers of distant metastases and poor prognosis in gynecological cancers［J］.BMC Cancer， 2019，19（1）：141.
［18］ Kumarasamy C， Sabarimurugan S， Madurantakam RM， et al. Prognostic significance of blood inflammatory biomarkers NLR， PLR， and LMR in cancer- a protocol for systematic review and meta-analysis［J］.Medicine （Baltimore）， 2019，98（24）：e14834.
［19］ 郑杰，朱艳丽，田成.血清CAR及炎症指标对老年食管癌患者放疗预后的预测价值［J］.中国老年学杂志，2023，43（10）：2361-2365.
［20］ Cassetta L， Fragkogianni S， Sims AH， et al. Human tumor-associated macrophage and monocyte transcriptional landscapes reveal cancer-specific reprogramming， biomarkers， and therapeutic targets［J］.Cancer Cell， 2019，35（4）：588-602.
［21］ Quigley DA， Kristensen V. Predicting prognosis and therapeutic response from interactions between lymphocytes and tumor cells［J］.Mol Oncol， 2015，9（10）：2054-2062.
［22］ Wang SC， Chou JF， Strong VE， et al. Pretreatment neutrophil to lymphocyte ratio independently predicts disease-specific survival in resectable gastroesophageal junction and gastric adenocarcinoma［J］.Ann Surg， 2016，263（2）：292-297.
［23］ Rolfes V， Ribeiro LS， Hawwari I， et al. Platelets fuel the inflammasome activation of innate immune cells［J］.Cell Rep， 2020，31（6）：107615.
［24］ Fan T， Kuang G， Long R， et al. The overall process of metastasis： from initiation to a new tumor［J］.Biochim Biophys Acta Rev Cancer， 2022，1877（4）：188750.
［25］ Cortiula F， Reymen B， Peters S， et al. Immunotherapy in unresectable stage Ⅲ non-small-cell lung cancer： state of the art and novel therapeutic approaches［J］.Ann Oncol， 2022，33（9）：893-908.
［26］ Feng F， Tian Y， Liu S， et al. Combination of PLR， MLR， MWR， and tumor size could significantly increase the prognostic value for gastrointestinal stromal tumors［J］.Medicine （Baltimore）， 2016，95（14）：e3248.
［27］ 胡浚伟.卡瑞利珠单抗联合放化疗在局部晚期非鳞非小细胞肺癌中的疗效及可能作用机制［D］.新乡： 新乡医学院， 2022.
［28］ 王逸飞，邓建华，刘晓学.卡瑞利珠单抗联合贝伐珠单抗及化疗在非鳞非小细胞肺癌肝转移患者中的疗效［J］.中国医学创新，2025，22（4）：1-5.
［29］ 刘小兰，许佳佳，潘桢婕，等.卡瑞利珠单抗一线治疗晚期非鳞非小细胞肺癌的疗效及安全性分析［J］.中国医药科学，2022，12（10）：149-152.
［30］ Zhou X， Yao Z， Bai H， et al. Treatment-related adverse events of PD-1 and PD-L1 inhibitor-based combination therapies in clinical trials： a systematic review and meta-analysis［J］.Lancet Oncol， 2021，22（9）：1265-1274.
［31］ Wang DY， Salem JE， Cohen JV， et al. Fatal toxic effects associated with immune checkpoint inhibitors： a systematic review and meta-analysis［J］.JAMA Oncol， 2018，4（12）：1721-1728.
［32］ Salama JK， Stinchcombe TE， Gu L， et al. Pulmonary toxicity in Stage Ⅲ non-small cell lung cancer patients treated with high-dose （74 Gy） 3-dimensional conformal thoracic radiotherapy and concurrent chemotherapy following induction chemotherapy： a secondary analysis of Cancer and Leukemia Group B （CALGB） trial 30105［J］.Int J Radiat Oncol Biol Phys， 2011，81（4）：e269-e274.
/
| 〈 |
|
〉 |