Analysis of factors influencing thyroid function abnormality and survival prognosis in advanced lung cancer patients treated with immune checkpoint inhibitors
10.3760/cma.j.cn431274-20240122-00142
- VernacularTitle:晚期肺癌患者应用免疫检查点抑制剂所致甲状腺功能异常的影响因素及生存预后分析
- Author:
Dan YU
1
;
Rui YAN
1
;
Guangyu AN
1
Author Information
1. 首都医科大学附属北京朝阳医院肿瘤科，北京 100020
- Publication Type:Journal Article
- Keywords:
Lung neoplasms;
Immune checkpoint inhibitors;
Thyroid function tests
- From:
Journal of Chinese Physician
2025;27(1):102-106
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the influencing factors and survival prognosis of thyroid function abnormality (TFA) induced by immune checkpoint inhibitors (ICI) in advanced lung cancer patients.Methods:Clinical data of advanced lung cancer patients who received ICI treatment in the Department of Oncology, the Beijing Chaoyang Hospital, Capital Medical University from January 1, 2019 to December 31, 2020 were retrospectively analyzed, and the patients were divided into TFA group and non-TFA group according to whether thyroid function was abnormal after ICI treatment. The baseline characteristics of the two groups were compared to evaluate the risk factors of TFA. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of each risk factor to TFA. The progression-free survival time (PFS) of patients with different lung cancer pathological types and different TFA subtypes were analyzed by Kaplan-Meier method. The influencing factors of PFS in lung cancer patients were evaluated by COX regression analysis.Results:The ratio of neutrophil to lymphocyte (NLR) in the TFA group was lower than that in the non-TFA group [2.55(1.64, 3.46) vs 3.47(2.27, 5.30), P=0.014]. The ratio of lymphocyte to monocyte (LMR) was higher than that of the non-TFA group [4.25(2.89, 6.40) vs 3.12(2.03, 5.33), P=0.037]. The lactate dehydrogenase (LDH) was lower than that in the non-TFA group [173(146, 215) U/L vs 196(177, 234)U/L, P=0.023]. The objective response rate (ORR) in the TFA group was better than that in the non-TFA group [75.8%(25/33) vs 39.5%(34/86), P=0.002]. ROC curve analysis results showed that low NLR (≤3.37), high LMR (>3.79) and low LDH (≤173 U/L) had certain predictive value for TFA in advanced lung cancer patients treated by ICI (all P<0.05). Survival analysis showed that PFS in the TFA group was better than that in the non-TFA group in patients with overall lung cancer ( P<0.001) and various pathological types [squamous cell carcinoma ( P=0.010), adenocarcinoma ( P=0.001) and small cell lung cancer ( P=0.045)]. There was no significant difference in PFS among different TFA subtypes ( P>0.05). COX regression analysis showed that TFA [ HR(95% CI): 0.439(0.278, 0.693)] and therapeutic effect [ HR(95% CI): 3.401(2.143, 5.399)] was an independent influencing factor for PFS in advanced lung cancer patients treated by ICI. Patients who developed TFA ( P<0.001) and responded to treatment ( P<0.001) indicated a good prognosis. Conclusions:Lung cancer patients with low NLR, low LDH, high LMR and effective treatment are more likely to develop TFA. Lung cancer patients with TFA have a better immunotherapy response and a better survival prognosis.
