Relationship between the level of neuron-specific enolase and the effect of sintilimab combined with platinum-based doublet-chemotherapy in the treatment of advanced small cell lung cancer

Zhang Dacan; Huang Caiyi; Huang Dongyi

doi:10.3760/j.issn.1673-4777.2024.12.004

Abstract：Objective To investigate the relationship between neuron-specific enolase(NSE)level and the effect of sintilimab combined with platinum-based doublet-chemotherapy in the treatment of advanced small cell lung cancer(SCLC).Methods The clinical data of 108 patients with advanced SCLC treated with sintilimab combined with platinum-based doublet-chemotherapy in Zhujiang Hospital,Southern Medical University from February 2022 to February 2024 were retrospectively analyzed.According to the clinical efficacy,the patients were divided into effective group(66 cases)and ineffective group(42 cases).The clinical data,T cell subsets,immu-noglobulin(Ig),pro-gastrin-releasing peptide(Pro-GRP)and NSE level were compared between the two groups.Multivariate Logistic regression was used to analyze the independent risk factors of ineffectiveness,and the independent correlation between NSE level and the ineffectiveness risk of sintilimab combined with platinum-based doublet-chemotherapy in the treatment of advanced SCLC was analyzed,and the sensitivity analysis was performed using the E-value method.Restricted cubic spline(RCS)model was established to analyze the dose-response relationship between serum NSE level and the ineffective risk of sintilimab combined with platinum-based doublet-chemotherapy in the treatment of advanced SCLC.Results There were significant differences in smoking history,tumor stage,CD3+,CD4+,CD8+,IgA,IgG,IgM,Pro-GRP level between the two groups(P＜0.05).There were significant differences in NSE level and ΔNSE1,ΔNSE2,ΔNSE3 and ΔNSE4 level after the first,second,third and fourth cycles of chemotherapy between the two groups(all P＜0.05).In the same group,the NSE level after each chemotherapy were significantly different from those after the last chemotherapy(all P＜0.05).Hierarchical regression analysis showed that CD3+,CD4+and CD8+had a significant positive effect on NSE level(all P＜0.05),and IgA and IgM had a significant positive effect on NSE level(both P＜0.05).After adjusting for smoking history,tumor stage and Pro-GRP,serum NSE level was still an independent risk factor for the inefficacy of sintil-imab combined with platinum-based doublet-chemotherapy in the treatment of advanced SCLC(odds ratio=2.620,95％confidence interval:1.538-4.580,P＜0.001).The trend test of NSE from low to high quintile groups was statistically significant(Ptrend＜0.001),and sensitivity analysis showed that the E-value was 2.619.RCS model analysis showed that there was a linear dose-response relationship between NSE level and the inefficacy risk of sindilizumab combined with platinum-based doublet-chemotherapy in the treatment of advanced SCLC(Pfor non linear=0.195).Subgroup analysis showed that the correlation between NSE and sintilimab combined with platinum-based doublet-chemotherapy in the treatment of advanced SCLC was stable in patients with different tumor stages,Pro-GRP,CD3+,CD4+,CD8+,IgA,IgG and IgM level,and there was no interaction between subgroups(all Pfor interaction＞0.05).Conclusion NSE level can significantly affect the clinical efficacy of sintilimab combined with platinum-based doublet-chemotherapy in the treatment of advanced SCLC.Patients with lower NSE level have better clinical efficacy.