系统免疫炎症营养指数对接受免疫检查点抑制剂治疗的非小细胞肺癌患者临床疗效及预后的评估价值研究

石明伟; 王俊康; 王静

doi:10.12435/j.issn.2095-5227.2023.092

系统免疫炎症营养指数对接受免疫检查点抑制剂治疗的非小细胞肺癌患者临床疗效及预后的评估价值研究

Predictive value of systemic immune inflammatory nutritional index for clinical efficacy and prognosis of non-small cell lung cancer patients receiving immune checkpoint inhibitors

摘要

摘要:
背景免疫检查点抑制剂(immune checkpoint inhibitors，ICIs)可提高非小细胞肺癌(non-small cell lung cancer，NSCLC)患者生存时间，但目前缺乏可监测免疫检查点抑制剂治疗效果和预后的生物指标。
目的探讨新指标——系统免疫炎症营养指数(systemic immune-inflammatory nutritional index，SIINI)对接受ICIs治疗的NSCLC患者临床效果及预后的评估价值。
方法收集2020年1月 - 2022年5月在合肥京东方医院治疗的126例NSCLC患者临床资料，所有患者均接受免疫药物治疗。采用多因素Logistic回归分析接受ICIs治疗的NSCLC患者疾病控制率(disease control rate，DCR)的关联因素，采用Cox回归分析接受ICIs治疗的NSCLC患者无进展生存期(progression free survival，PFS)的影响因素。
结果 126例NSCLC患者，男性88例，女性38例；≥60岁81例，＜60岁45例。经过治疗，客观缓解率为27.78%，DCR为73.02%。Logistic回归结果显示：TNM分期为ⅢB ~ ⅢC期(OR=0.449，95% CI：0.224 ~ 0.898)、转移部位个数＜3个(OR=0.345，95% CI：0.122 ~ 0.970)、中性粒细胞/淋巴细胞比值(neutrophil to lymphocyte ratio，NLR)≤2.61(OR=0.244，95% CI：0.089 ~ 0.670)、SIINI≤95.34(OR=0.284，95% CI：0.107 ~ 0.751)的NSCLC患者疗效更佳(P＜0.05)；Cox回归结果显示：年龄≥60岁(HR=1.811，95% CI：1.073 ~ 3.059)、TNM分期为Ⅳ期(HR=2.364，95% CI：1.253 ~ 4.458)、SIINI＞95.34(HR=1.543，95% CI：1.037 ~ 3.407)是接受ICIs治疗NSCLC患者PFS的危险因素(P＜0.05)。
结论 SIINI可能是接受ICIs治疗NSCLC患者DCR的独立影响因素，可作为NSCLC患者免疫治疗疗效及预后的预测指标。

Abstract:
Background Immunocheckpoint inhibitors (ICIs) can improve the survival time of patients with non-small cell lung cancer (NSCLC), but there is still a lack of related bioindicator that affect the therapeutic effect and prognosis of immunocheckpoint inhibitors.
Objective To explore the predictive value of the clinical effect and prognosis of the new index system immuno-inflammatory nutrition index (SIINI) on NSCLC patients treated with ICIs.
Methods Clinical data about 126 NSCLC patients in Hefei BOE Hospital from January 2020 to May 2022 were collected, and all patients were treated with immunopharmaceuticals. Multivariate logistic regression analysis was used to analyze the influencing factors of disease control rate (DCR) of NSCLC patients treated with ICIs, and Cox regression analysis was applied to analyze the influencing factors of disease progression free survival (PFS) in NSCLC patients receiving ICIs treatment.
Results A total of 126 NSCLC patients were included, with 88 males and 38 females; 81 patients were aged 60 or older, and 45 patients were younger than 60. The objective response rate (ORR) and DCR of these patients after treatment were 27.78% and 73.02%, respectively. Logistic regression results showed that NSCLC patients with TNM stage at ⅢB - ⅢC (OR=0.449, 95% CI: 0.224-0.898), the number of metastatic sites less than 3 (OR=0.345, 95% CI: 0.122-0.970), NLR ≤ 2.61 (OR=0.244, 95% CI: 0.089-0.670), and SIINI ≤ 95.34 (OR=0.284, 95% CI: 0.107-0.751) had better efficacy (P＜0.05). Cox regression results showed that age ≥ 60 years old (HR=1.811, 95% CI: 1.073-3.059), TNM stage Ⅳ (HR=2.364, 95% CI: 1.253-4.458), and SIINI>95.34 (HR=1.543, 95% CI: 1.037-3.407) were risk factors for PFS in NSCLC patients receiving ICIs treatment (P＜0.05).
Conclusion SIINI may be an independent influencing factor for DCR in patients with NSCLC treated with ICIs, and may be used as a predictor of the efficacy and prognosis of immunotherapy for patients with NSCLC.

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