外周血淋巴细胞亚群联合程序性死亡配体-1表达在宫颈癌化疗联合免疫治疗疗效预测中的价值OA

Objective To investigate the predictive value of peripheral blood lymphocyte subsets and tumor tissue programmed death-ligand 1(PD-L1)expression level for the efficacy of chemothera-py combined with immunotherapy in cervical cancer.Methods A total of 124 patients with cervical cancer(74 with locally advanced disease and 50 with recurrent or metastatic disease)who received chemotherapy combined with programmed death-1(PD-1)inhibitors were enrolled.The proportions of peripheral blood CD3+,CD4+,CD8+T lymphocytes and NK cells before treatment were detected by flow cytometry.The expression level of PD-L1 in tumor tissues was detected by immunohistochemistry using the combined positive score(CPS).According to the efficacy evaluation results at 6 months after treatment,the patients were divided into response group(complete response+partial response)and non-response group(stable disease+progressive disease),and the differences in immune indica-tors between the two groups were compared.Logistic regression analysis was used to identify inde-pendent influencing factors of efficacy,and the receiver operating characteristic(ROC)curve was used to evaluate the predictive performance.Results Before treatment,the proportions of peripher-al blood CD3+T cells and CD4+T cells,as well as the CD4+/CD8+in the response group were significantly higher than those in the non-response group,while the proportions of CD8+T cells and NK cells were significantly lower than those in the non-response group(P＜0.001 or P＜0.01).The objective response rate(ORR)of the high PD-L1 expression group(CPS ≥ 10,n=57)was 68.42％,which was significantly higher than 37.31％of the low expression group(CPS＜10,n=67)(x2=12.347,P＜0.001).Multivariate Logistic regression showed that the CD4+/CD8+(OR=3.421,95％CI:1.892-6.187,P＜0.001)and PD-L1 CPS(OR=2.876,95％CI:1.634-5.062,P＜0.001)were independent predictors of the efficacy of chemotherapy combined with im-munotherapy for cervical cancer.The area under the curve(AUC)of the combined prediction model incorporating the CD4+/CD8+ratio and PD-L1 CPS(≥ 10)was 0.892(95％CI:0.831-0.953),which was superior to that of any single indicator.Conclusion Peripheral blood lymphocyte subsets combined with PD-L1 expression level can effectively predict the efficacy of chemotherapy combined with immunotherapy for cervical cancer.The predictive performance of the combination is significantly superior to that of any single indicator,demonstrating important clinical application value.