Efficacy prediction of peripheral blood T-lymphocyte levels to chemotherapy combined with immunotherapy in advanced small cell lung cancer
WU Qin
LIU Chunxia
WANG Baoqing
Abstract：Objective To investigate the predictive value and clinical significance of peripheral blood T-lymphocyte subset levels in evaluating the efficacy of chemotherapy combined with immunotherapy in advanced small cell lung cancer(SCLC).Methods A total of 107 patients with advanced SCLC who underwent chemotherapy combined with immunotherapy at the Department of Respiratory Medicine,Zhongshan Hospital Affiliated to Fudan University,from September 2023 to June 2024,were enrolled.Patients were categorized into an effective group(72 cases,CR+PR+SD)and an ineffective group(35 cases,PD)based on the Response Evaluation Criteria in Solid Tumors(RECIST 1.1).Dynamic changes in peripheral blood T-lymphocyte subsets(CD4+,CD8+,CD4+/CD8+ratio)and tumor markers(carcinoembryonic antigen[CEA]and neuron-specific enolase[NSE])were compared before and after treatment in efficacy groups,and the predictive value of the above indexes on the efficacy of SCLC chemotherapy combined with immunotherapy was analyzed.Results Peripheral blood T-lymphocyte subsets(CD4+,CD8+,and CD4+/CD8+ratio)showed no correlation with age,gender,or TNM stage(all P＞0.05).After 2 treatment cycles,the effective group demonstrated a significantly higher CD4+/CD8+ratio(P=0.003)and lower CEA and NSE levels(P＜0.001)compared to the ineffective group.By the 4th cycle,the effective group exhibited elevated CD4+levels(P=0.012),reduced CD8+levels(P＜0.001),and a further increased CD4+/CD8+ratio(P＜0.001),with sustained suppression of CEA and NSE(all P＜0.001).ROC analysis revealed that the CD4+/CD8+ratio provided optimal independent predictive efficacy(AUC=0.812,95%CI:0.726-0.897),and the AUC of CEA and NSE was 0.661 and 0.634,respectively.while combined assessment of CD4+/CD8+ratio,CEA,and NSE significantly enhanced predictive efficacy(AUC=0.834,95%CI:0.741-0.912),outperforming individual markers(Delong test,P＜0.05).Conclusions Dynamic monitoring of peripheral blood T-lymphocyte subsets combined with tumor marker detection offers an objective basis for evaluating therapeutic efficacy in advanced SCLC treated with chemoimmunotherapy.The integration of CD4+/CD8+ratio with CEA and NSE holds high prognostic value.
Keywords：Small cell lung cancerChemotherapyImmunotherapyPrognostic efficacy predictionPeripheral blood lymphocyte subsets
Publication Date：2025-04-20
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：5( 185-189 )