Öz
Amaç
Sistemik enflamasyon, ileri evre küçük hücreli dışı akciğer kanserinde (KHDAK) tümör progresyonu ve tedavi yanıtında önemli bir rol oynamaktadır. Enflamasyon temelli biyobelirteçler arasında sistemik immün-enflamasyon indeksi (SII) ve sistemik enflamatuvar yanıt indeksi (SIRI), son yıllarda prognostik araçlar olarak dikkat çekmiştir. Bu çalışma, ikinci basamak nivolumab tedavisi alan metastatik KHDAK hastalarında SII ve SIRI’nın progresyonsuz sağkalım (PFS) ve genel sağkalım (OS) üzerindeki etkisini değerlendirmeyi amaçlamıştır.
Yöntem
İkinci basamak nivolumab tedavisi alan 216 metastatik KHDAK hastasının retrospektif analizi gerçekleştirildi. SII ve SIRI değerleri başlangıç hematolojik parametrelerden hesaplandı. Eğri altında kalan alan analizi ile optimal kesim noktaları belirlendi ve bu indekslerin OS ve PFS ile ilişkileri değerlendirildi. Metastatik dağılım, önceki tedavi yanıtı ve nivolumab kür sayısı gibi klinik değişkenler univaryant ve multivaryant Cox regresyon modellerine dahil edildi.
Bulgular
Ortalama 24 aylık takip sonrasında medyan OS 27,7 ay, medyan PFS ise 12,6 ay olarak hesaplandı. SIRI için ≥2086 kesim değeri, artmış mortalite ve progresyon riski ile güçlü şekilde ilişkili bulundu. Buna karşın SII anlamlı bir ayırt edici değer göstermedi. Nivolumab kür sayısı, hastalık seyri ile ilişkili prognostik bir gösterge olarak değerlendirildi; daha az kür alabilen hastalarda daha kısa sağkalım gözlenmiştir. Ayrıca çoklu organ metastazı ve önceki tedavi sırasında progresyon, bağımsız kötü prognostik faktörler olarak saptandı.
Sonuç
SIRI ve nivolumab kür sayısı, ikinci basamak immünoterapi alan metastatik KHDAK hastalarında sağkalım ile ilişkili, klinik olarak uygulanabilir prognostik parametreler olarak değerlendirilebilir. SII’nın anlamlı prognostik katkı sağlamaması, bu tedavi bağlamında SIRI’nın daha güvenilir bir enflamasyon temelli belirteç olabileceğini düşündürmektedir. Bulgular, enflamatuvar indekslerin klinik parametrelerle birlikte kullanılarak risk sınıflamasının iyileştirilebileceğini ve hasta yönetiminin optimize edilebileceğini göstermektedir.
Anahtar Kelimeler:
Genel sağkalım, küçük hücreli dışı akciğer kanseri, nivolumab, prognostik biyobelirteçler, progresyonsuz sağkalım, sistemik enflamatuvar yanıt indeksi, sistemik immün-enflamasyon indeksi
Kaynaklar
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