Chun Yee Ryan Ho, Ka Man Cheung, Chung Hang James Chow, Gavin Tin Chun Cheung
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引用次数: 0
Abstract
Introduction: Pulmonary lymphoepithelioma-like carcinoma (pLELC) is a rare form of non-small cell lung cancer. As immunotherapy (IO) becomes an important treatment for advanced pLELC, identifying reliable prognostic markers is crucial for guiding clinical decisions and resource allocation.
Methods: This multicentre retrospective cohort study included 26 patients with advanced or metastatic pLELC who received palliative IO at two tertiary hospitals in Hong Kong from 2010 to 2023. Clinical and haematological data, particularly eosinophil peak timing, eosinophil-to-neutrophil ratio (ENR), and neutrophil-to-lymphocyte ratio (NLR), were obtained at each treatment cycle. Progression-free survival (PFS) and overall survival (OS) were evaluated using Kaplan-Meier analysis. Cox regression models, complemented by landmark and sensitivity analyses, were used to determine independent prognostic factors.
Results: Early eosinophil peak (≤5 weeks after starting IO) was significantly linked to shorter PFS (HR 7.0, p = 0.007), while ENR <0.054 independently predicted poorer PFS (HR 2.9, p = 0.04). Neither ENR nor NLR showed significant associations with OS in multivariate analysis. Delayed eosinophil peaks were associated with more favourable PFS, supporting the prognostic value of eosinophil kinetics. Sensitivity analyses confirmed these findings were robust across patient subgroups.
Conclusions: Eosinophil peak timing is a practical, independent biomarker for identifying pLELC patients less likely to benefit from IO and may enhance patient prognostication and management. Further prospective studies in larger, multi-centre cohorts are needed to validate the clinical use of eosinophil dynamics in IO monitoring for pLELC.
肺淋巴上皮瘤样癌(pLELC)是一种罕见的非小细胞肺癌。随着免疫治疗(IO)成为晚期pLELC的重要治疗手段,确定可靠的预后标志物对于指导临床决策和资源分配至关重要。方法:这项多中心回顾性队列研究纳入了2010年至2023年在香港两家三级医院接受姑息性IO治疗的26例晚期或转移性pLELC患者。在每个治疗周期获得临床和血液学数据,特别是嗜酸性粒细胞峰值时间,嗜酸性粒细胞与中性粒细胞比值(ENR)和中性粒细胞与淋巴细胞比值(NLR)。采用Kaplan-Meier分析评估无进展生存期(PFS)和总生存期(OS)。采用Cox回归模型,辅以里程碑分析和敏感性分析,确定独立的预后因素。结果:早期嗜酸性粒细胞峰值(开始IO后≤5周)与较短的PFS显著相关(HR 7.0, p = 0.007),而ENR结论:嗜酸性粒细胞峰值时间是一种实用的、独立的生物标志物,可用于识别不太可能从IO中获益的pLELC患者,并可增强患者的预后和管理。需要在更大的多中心队列中进行进一步的前瞻性研究,以验证嗜酸性粒细胞动力学在IO监测pLELC中的临床应用。