关键词:

非小细胞肺癌, 肿瘤突变负荷, 新辅助免疫治疗, 免疫浸润.

Abstract:

Objective To observe the TMB，immune infiltration and PD ⁃L1 expression in patients with gene⁃negative NSCLC after neoadjuvant immunotherapy，and analyze the prognostic factors. Methods 51 NSCLC patients from the Affiliated Tumor Hospital of Harbin Medical University since 2015 were collected and retrospective. The driver gene of lung tissue punctured patients were negative by the 9⁃in⁃1 lung cancer test kit，and the patients underwent neoadjuvant immunotherapy before surgical resection. High⁃throughput sequencing technology was used to detect the TMB of patients，anti⁃CD8 and anti⁃PD⁃L1 antibodies were used to detect immune infiltration and PD⁃L1 expression. The patients were followed up for up to 5 years，the PFS of the patients was recorded，and the Kaplan⁃Meier method was used to analyze the prognostic factors in patients with driver gene⁃negative NSCLC after neoadjuvant immunotherapy. Results The PFS between PD ⁃L1 positive patients（PD ⁃L1 +）and PD ⁃L1 negative patients（PD⁃L1-）had no significant difference（P = 0.461 1）. The PFS of TMB high mutation patients（TMB+） were longer than TMB low mutation patients（TMB-）（P = 0.004 7）. The PFS of CD8 positive patients（CD8 +） were longer than CD8 negative patients（CD8-）（P = 0.001 4）. The PFS of PD⁃L1+ /TMB+ patients were longer than others（P = 0.001 9）. The PFS between PD⁃L1- /TMB+ patients and others had no significant difference（P = 0.361 1）. The PFS of CD8 + /TMB+ patients were longer than others（P = 0.036 9）. The PFS of CD8 + /PD ⁃L1 + patients were longer than others（P = 0.016 1）. The PFS of TMB+ /CD8+ /PD⁃L1+ patients were longer than others（P = 0.037 7）.Conclusion For operable NSCLC patients with negative driver genes，a comprehensive analysis of TMB，PD⁃L1 expression and immune infiltration is helpful to choice the treatment paln for patients.

Key words:

non ? small cell lung cancer, tumor mutation burden, neoadjuvant immunotherapy, Immune infiltration