联合检测LDHA和PD-L1在晚期胃癌PD-1抑制剂疗效预测及预后评估中的价值

左学良; 陈志强; 董润雨; 王智雄; 蔡娟

doi:10.19401/j.cnki.1007-3639.2023.05.006

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联合检测LDHA和PD-L1在晚期胃癌PD-1抑制剂疗效预测及预后评估中的价值

论著 | 更新时间：2025-12-31

- 联合检测LDHA和PD-L1在晚期胃癌PD-1抑制剂疗效预测及预后评估中的价值
- The value of combined detection of LDHA and PD-L1 in predicting the efficacy and prognosis of advanced gastric cancer patients treated with PD-1 inhibitor
- 中国癌症杂志 2023年33卷第5期页码：460-468
- 作者机构：
  
  1. 皖南医学院第一附属医院（弋矶山医院）胃肠外科，安徽芜湖 241001
  2. 重大疾病非编码RNA转化研究安徽普通高校重点实验室，安徽芜湖 241001
  3. 南京医科大学第一附属医院肝胆中心，江苏南京 210029
  4. 皖南医学院第一附属医院（弋矶山医院）肿瘤内科，安徽芜湖 241001
- 作者简介：
  
  [ "左学良（ORCID: 0000-0001-5204-2585），博士，副主任医师。" ]
  蔡娟（ORCID: 0000-0001-7996-2525），博士，副主任医师。
- 基金信息：
  
  国家自然科学基金(82103293);安徽省高校优秀青年人才支持计划(gxyq2021257);芜湖市科技计划(2022jc52)
- DOI：10.19401/j.cnki.1007-3639.2023.05.006
  中图分类号： R735.2
- 收稿：2022-10-26，
  
  修回：2023-03-02，
  
  纸质出版：2023-05-30
- 稿件说明：
移动端阅览
左学良, 陈志强, 董润雨, 等. 联合检测LDHA和PD-L1在晚期胃癌PD-1抑制剂疗效预测及预后评估中的价值[J]. 中国癌症杂志, 2023,33(5):460-468.

Xueliang ZUO, Zhiqiang CHEN, Runyu DONG, et al. The value of combined detection of LDHA and PD-L1 in predicting the efficacy and prognosis of advanced gastric cancer patients treated with PD-1 inhibitor[J]. China Oncology, 2023, 33(5): 460-468.
左学良, 陈志强, 董润雨, 等. 联合检测LDHA和PD-L1在晚期胃癌PD-1抑制剂疗效预测及预后评估中的价值[J]. 中国癌症杂志, 2023,33(5):460-468. DOI： 10.19401/j.cnki.1007-3639.2023.05.006.

Xueliang ZUO, Zhiqiang CHEN, Runyu DONG, et al. The value of combined detection of LDHA and PD-L1 in predicting the efficacy and prognosis of advanced gastric cancer patients treated with PD-1 inhibitor[J]. China Oncology, 2023, 33(5): 460-468. DOI： 10.19401/j.cnki.1007-3639.2023.05.006.

摘要

背景与目的：

胃癌对程序性死亡[蛋白

]

-1（programmed death-1，PD-1）抑制剂的应答率较低，建立有用的疗效预测方法筛选胃癌PD-1抑制剂治疗优势人群对改善患者预后有重要意义。本研究旨在探讨联合检测乳酸脱氢酶A（lactate dehydrogenase，LDHA）和程序性死亡[蛋白

]

配体-1（programmed death ligand-1，PD-L1）表达对接受PD-1抑制剂治疗胃癌患者的疗效预测和预后评估价值。

方法：

回顾性分析皖南医学院第一附属医院2020年1月—2022年3月接受PD-1抑制剂治疗的50例晚期胃癌患者的临床病理学资料，采用多因素logistic回归分析影响胃癌PD-1抑制剂疗效的独立危险因素，利用受试者工作特征（receiver operating characteristic，ROC）曲线分析联合检测LDHA和PD-L1对胃癌PD-1抑制剂疗效的预测价值，应用Kaplan-Meier法对患者进行生存分析。

结果：

LDHA低表达组和高表达组胃癌患者的客观缓解率（objective response rate，ORR）分别为59%和10%，疾病控制率（disease control rate，DCR）分别为83%和29%，差异有统计学意义（

0.001）。多因素logistic回归分析结果显示，PD-L1阳性联合分数（combined positive score，CPS）

5、LDHA高表达是胃癌PD-1抑制剂疗效不佳的独立危险因素（

0.05）。ROC曲线分析结果提示LDHA联合PD-L1具有较好的胃癌PD-1抑制剂疗效预测价值[曲线下面积（area under curve，AUC）为0.951

]

。Kaplan-Meier生存分析显示，LDHA低表达合并PD-L1 CPS≥5的胃癌患者在接受PD-1抑制剂治疗后具有更长的总生存期（overall survival，OS，

=0.003）和无进展生存期（progression-free survival，PFS，

0.001）。

结论：

LDHA低表达、PD-L1 CPS≥5与胃癌PD-1抑制剂的疗效呈正相关，LDHA低表达合并PD-L1 CPS≥5的胃癌患者接受PD-1抑制剂治疗可显著延长OS和PFS，联合检测LDHA和PD-L1对晚期胃癌患者PD-1抑制剂的疗效预测和预后评估有一定的临床应用价值。

Abstract

Background and purpose:

The response rate of gastric cancer patients to programmed death-1 (PD-1) inhibitor is relatively low. Establishing a useful efficacy prediction method to screen the superior gastric cancer patients receiving anti-PD-1 therapy could improve the prognosis of patients. This study aimed to explore the value of combined detection of lactate dehydrogenase (LDHA) and programmed death ligand-1 (PD-L1) expressions in predicting the efficacy and prognosis of gastric cancer patients treated with PD-1 inhibitor.

Methods:

The clinicopathological data of 50 advanced gastric cancer patients treated with PD-1 inhibitor in The First Affiliated Hospital of Wannan Medical College from January 2020 to March 2022 were retrospectively analyzed. The independent risk factors affecting the efficacy of PD-1 inhibitor were analyzed by multivariate logistic regression. The value of combined detection of LDHA and PD-L1 in predicting the efficacy of PD-1 inhibitors in gastric cancer was analyzed by receiver operating characteristic (ROC) curve analysis. Gastric cancer patient survival was analyzed by Kaplan-Meier method.

Results:

The objective response rate (ORR) of gastric cancer patients receiving PD-1 inhibitor therapy in LDHA low and high expression groups were 59% and 10%

respectively. The disease control rate (DCR) in LDHA low and high expression groups were 83% and 29%

respectively. The difference was statistically significant (

0.001). Multivariate logistic regression analysis showed that PD-L1 combined positive score (CPS)

5 and LDHA high expression were independent risk factors affecting the efficacy of PD-1 inhibitor in gastric cancer (

0.05). ROC curve analysis showed that combined detection of LDHA and PD-L1 had good predictive value for the efficacy of PD-1 inhibitor in gastric cancer [area under curve (AUC) was 0.951

]

. Kaplan-Meier

survival analysis showed that gastric cancer patients with low LDHA expression and PD-L1 CPS≥5 had longer overall survival (OS

=0.003) and progression-free survival (PFS

0.001) after receiving PD-1 inhibitor therapy.

Conclusion:

Low LDHA expression and PD-L1 CPS≥5 were positively correlated with the efficacy of PD-1 inhibitor in gastric cancer. Gastric cancer patients with low LDHA expression and PD-L1 CPS≥5 significantly had prolonged OS and PFS after receiving PD-1 therapy. Therefore

the combined detection of LDHA and PD-L1 expressions has good value in predicting the efficacy and evaluating prognosis of advanced gastric cancer patients treated with PD-1 inhibitor.

关键词

Keywords

references

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