四川大学学报（医学版）2025，Vol.56Issue(2)：514-520,7.DOI:10.12182/20250360104
PD-1/PD-L1抑制剂致肺癌患者甲状腺功能异常的临床特征及其疗效预测价值
Clinical Features of PD-1/PD-L1 Inhibitors-Related Thyroid Dysfunction in Lung Cancer Patients and Their Predictive Value for Therapeutic Efficacy
摘要
Abstract
Objective To investigate the clinical features of thyroid dysfunction in lung cancer patients treated with programmed cell death receptor-1(PD-1)or programmed cell death receptor-ligand 1(PD-L1)and their value for predicting therapeutic efficacy.Methods Lung cancer patients treated with PD-1/PD-L1 inhibitors at West China Hospital,Sichuan University between March 2018 and September 2022 were retrospectively enrolled.Data concerning the medical records,therapeutic efficacy,and thyroid function indicators of the patients were retrieved from the hospital electronic medical record information system.The data were then analyzed to identify risk factors and predictive factors for immune-related adverse events(irAEs)of the thyroid.The predictive value of thyroid irAEs for treatment efficacy and prognosis was assessed.Objective response rate(ORR)was defined as the indicator for therapeutic efficacy and progression-free survival(PFS)was defined as the prognostic indicator.Results A total of 368 lung cancer patients were enrolled.Among them,31.5％(116/368)developed thyroid irAEs.According to the results of logistic regression analysis,baseline thyroid stimulating hormone(TSH)concentration and baseline positive results for thyroglobulin antibody(TGAb)and thyroid peroxidase antibody(TPOAb)were risk factors for thyroid dysfunction caused by PD-1/PD-L1 inhibitors.Among the three measures,baseline TPOAb concentration demonstrated good predictive value for thyroid irAEs,with an area under the receiver-operating characteristic(ROC)curve(AUC)of 0.745.Patients with thyroid irAEs had a longer median PFS(16.0 months vs.9.7 months,P＜0.001)and a higher ORR(55.2％vs.34.9％,P＜0.001)compared to those without thyroid irAEs.Patients with thyroid irAEs had a better ORR than those without thyroid irAEs did.It was more likely for patients with thyroid irAEs to achieve an objective response compared to those without thyroid irAEs(odds ratio[OR]=2.29;95％CI,1.46-3.60).Conclusion In lung cancer patients treated with the PD-1/PD-L1 inhibitors,the TPOAb antibody demonstrates good predictive value for thyroid irAEs.Patients who develop thyroid irAEs have better treatment outcomes and prognosis.关键词
程序性死亡受体-1/肺肿瘤/甲状腺功能减退症/甲状腺毒症/甲状腺过氧化物酶抗体Key words
Programmed death receptor-1/Lung neoplasms/Hypothyroidism/Thyrotoxicosis/Thyroid peroxidase antibody引用本文复制引用
林思屹,刘燕扬,赵凤,江秋晓,杨舒羽,张禾,冯彬,干伟..PD-1/PD-L1抑制剂致肺癌患者甲状腺功能异常的临床特征及其疗效预测价值[J].四川大学学报（医学版）,2025,56(2):514-520,7.基金项目
四川省自然科学基金项目(No.2022NSFSC1283)资助 （No.2022NSFSC1283）
