Author:
Zheng Xinlong,Zhang Longfeng,Wu Lin,Zhao Jun,Sun Jianguo,Fang Yong,Zhou Jin,Chu Qian,Shen Yihong,Yang Zhenzhou,Chen Lijin,Huang Meijuan,Lin Xiaoyan,Liu Zhenhua,Shen Peng,Wang Zhijie,Wang Xin,Wang Huijuan,Han Zhengbo,Liu Anwen,Zhang Hongmei,Ye Feng,Gao Wen,Wu Fang,Song Zhengbo,Chen Shengchi,Zhou Chenzhi,Wang Qian,Xu Chunwei,Huang Dingzhi,Zheng Xiaobin,Miao Qian,Jiang Kan,Xu Yiquan,Wu Shiwen,Wang Haibo,Zhang Qiuyu,Yang Shanshan,Li Yujing,Chen Sihui,Lin Gen
Abstract
Abstract
Aims
To investigate the predictive value of baseline C-reactive protein (CRP) levels on the efficacy of chemotherapy plus immune checkpoint inhibitors (ICI) in patients with advanced lung squamous cell carcinoma (LSCC).
Materials and methods
In this retrospective multicenter study spanning from January 2016 to December 2020, advanced LSCC patients initially treated with chemotherapy or a combination of chemotherapy and ICI were categorized into normal and elevated CRP subgroups. The relationship between CRP levels and treatment outcomes was analyzed using multivariate Cox proportional hazards models and multivariate logistic regression, focusing primarily on the progression-free survival (PFS) endpoint, and secondarily on overall survival (OS) and objective response rate (ORR) endpoints. Survival curves were generated using the Kaplan-Meier method, with the log-rank test used for comparison between groups.
Results
Of the 245 patients evaluated, the 105 who received a combination of chemotherapy and ICI with elevated baseline CRP levels exhibited a significant reduction in PFS (median 6.5 months vs. 11.8 months, HR, 1.78; 95% CI: 1.12–2.81; p = 0.013) compared to those with normal CRP levels. Elevated CRP was identified as an independent risk factor for poor PFS through multivariate-adjusted analysis. However, among the 140 patients receiving chemotherapy alone, baseline CRP levels did not significantly influence PFS. Furthermore, within the combination therapy group, there was a notable decrease in the ORR (51% vs. 71%, p = 0.035), coupled with a significantly shorter OS (median 20.9 months vs. 31.5 months, HR, 2.24; 95% CI: 1.13–4.44; p = 0.033).
Conclusion
In patients with advanced LSCC, elevated baseline CRP levels were identified as an independent predictive factor for the efficacy of combination therapy with chemotherapy and ICI, but not in chemotherapy alone. This suggests that CRP may be a valuable biomarker for guiding treatment strategies.
Publisher
Springer Science and Business Media LLC
Subject
Cancer Research,Genetics,Oncology