晚期非小细胞肺癌患者预后的影响因素分析OA

Objective To explore factors affecting prognosis of patients with advanced non-small cell lung cancer(NSCLC).Methods A retrospective selection was performed on 110 patients with advanced NSCLC who were treated at Taizhou Central Hospital from January 2019 to January 2022 as the research subjects.According to the treatment results,the patients were divided into a good prognosis group of 89 cases and a poor prognosis group of 21 cases.The clinicopathological characteristics of the two groups of patients were compared.Chromosomal instability(CIN)was detected by whole-genome ultra-low coverage sequencing technology.Proliferating cell nuclear antigen(Ki-67)and novel aspartie proteinase A(NapsinA)were detected by immunohistochemical staining.Cluster of differentiation(CD)3,CD4,and CD8 were calculated.The positive rates of anti-programmed death-ligand 1(PD-L1)and pan-cytokeratin(Pan-CK)were compared.The positive rates of tissue sections in the two groups of patients were compared,and Spearman rank correlation was used to investigate the correlations of PD-L1,Pan-CK,CD3,CD4,and CD8 with poor prognosis.Univariate and multivariate Cox regression analysis was used to analyze the factors influencing the prognosis of NSCLC patients.The Kaplan-Meier survival curve was plotted,and the log-rank test was used to analyze the survival status of patients.Results There were statistically significant differences between the two groups of patients in the metastasis of other sites,the number of distant metastatic sites and the serum lactate dehydrogenase(LDH)level(all P＜0.05).There was no statistically significant difference in the type of CIN variation between the two groups of patients(P＞0.05).The positive rates of CD3,CD4 and CD8 in the good prognosis group were higher than those in the poor prognosis group,while the positive rates of PD-L1 and Pan-CK were lower than those in the poor prognosis group(all P＜0.05).Spearman rank correlation analysis showed that the positive rates of PD-L1 and Pan-CK in NSCLC patients were positively correlated with poor prognosis,with correlation coefficients of 0.520 and 0.320(both P＜0.05),while the positive rates of CD3,CD4 and CD8 were negatively correlated with poor prognosis,with correlation coefficients of-0.310,-0.620,and-0.650(all P＜0.05).Multivariate Cox regression analysis revealed that both CD8+T cell infiltration and PD-L1 expression were independent prognostic factors for NSCLC patients(both P＜0.05).A total of 31 patients survived in the good prognosis group,with a survival rate of 34.83％,while two patients survived in the poor prognosis group,with a survival rate of 9.52％.There was a statistically significant difference in the survival rate between the two groups of patients(P=0.018).Conclusion The prognosis of patients with advanced NSCLC is closely related to metastatic burden,serum LDH level and immune status of the tumor microenvironment.Abnormal expressions of PD-L1,Pan-CK,CD3,CD4 and CD8 may all be important influencing factors for poor prognosis of NSCLC patients.