A study on the relationship between serum TRAIL level and immunotherapy response in patients with advanced non-small cell lung cancer

ZHANG Yajun; ZHANG Zhen'an; WANG Jihua; ZHOU Yuan; LIANG Fengxia

doi:10.3969/j.issn.1674-3806.2024.06.10

Abstract：Objective To explore the relationship between serum tumor necrosis factor-related apoptosis-inducing ligand(TRAIL)level and immunotherapy response in patients with advanced non-small cell lung cancer(NSCLC).Methods The clinical data of 70 patients with advanced NSCLC who were admitted to Tangshan People's Hospital from January 2019 to May 2020 were retrospectively analyzed.The serum TRAIL level was determined by using enzyme-linked immu-nosorbent assay(ELISA)within 24 hours before immunotherapy.Immunotherapy response was assessed by using objective response rate(ORR)and clinical benefit rate(CBR).The relationship of the patients'serum TRAIL levels with immuno-therapy response,lung function,emphysema and clinical prognosis was analyzed.Results After immunotherapy,23 patients with NSCLC achieved objective remission and 46 patients achieved clinical benefit.The serum TRAIL level in patients with objective remission was significantly higher than that in patients without objective remission[27.77(23.13,39.13)pg/mL vs 12.36(8.76,18.15)pg/mL;Z=-4.508,P＜0.001].The serum TRAIL level in patients with clinical benefit was significantly higher than that in patients without clinical benefit[23.13(16.99,30.63)pg/mL vs 11.75(8.76,15.56)pg/mL;Z=-4.887,P＜0.001].The results of Spearman rank correlation analysis showed that serum TRAIL level was positively correlated with forced expiratory volume in 1 second(FEV1)/forced vital capacity(FVC)(rs=0.288,P=0.016),and negatively correlated with total emphysema ratio(rs=-0.257,P=0.032)and lobar emphysema rate(LER)(rs=-0.324,P=0.006).The results of multivariate logistic regression analysis showed that taking serum TRAIL level＞27.46 pg/mL as a reference,patients with serum TRAIL level＜18.15 pg/mL had a significantly increased risk of not achieving objective remission and clinical benefit after immunotherapy(P＜0.05).The results of receiver operating characteristic(ROC)curve analysis showed that serum TRAIL level could effectively predict the response of NSCLC patients to immunotherapy(P＜0.05).The overall survival(OS)and progression-free survival(PFS)prognoses of the high TRAIL level group(serum TRAIL ≥18.15 pg/mL)were significantly better than those of the low TRAIL level group(serum TRAIL＜18.15 pg/mL)(P＜0.05).Conclusion Low serum TRAIL level is associated with non-response to immunotherapy and poor clinical prog-nosis in advanced NSCLC patients,and monitoring this indicator helps to screen NSCLC patients who can benefit from immunotherapy.