全身免疫炎症指数对非小细胞肺癌免疫检查点抑制剂疗效的预测价值

Predictive value of systemic immune inflammation index in the treatment of PD-1/PD-L1 immune checkpoint inhibitors in non-small cell lung cancer

目的 研究全身免疫炎症指数(systemic immune-inflammation index,SII)对非小细胞肺癌(non small cell lung cancer,NSCLC)患者免疫治疗疗效的预测价值。方法 选取自2019年1-12月期间我院接受免疫治疗的88例NSCLC患者临床资料。应用时间依赖的受试者工作曲线判断SII的最佳截断值。统计学分析比较两组临床治疗疗效及与临床病理特征的关系。Kaplan-Meier生存分析(Log-Rank检验)不同SII水平患者生存预后的差异。单因素及多因素Cox回归分析影响接受免疫治疗的NSCLC患者生存预后的危险因素。结果 SII的最佳截断值为423。SII与NSCLC患者肿瘤分期有关(均P <0.05)。高SII组疾病控制率为23.26%(10/43),明显低于低SII组53.33%(24/45),差异有统计学意义(χ2=8.390,P=0.004)。高SII组3年总体生存率为18.60%(8/43),明显低于低SII组51.11%(23/45)(Log-rankχ2=6.721,P <0.001);高SII组中位总体生存时间为16.25(9.20~19.36)个月,明显低于低SII组22.23(14.57~26.92)个月(U=4.886,P <0.001)。肿瘤分期Ⅳ期(HR=1.637,95%CI:1.054~2.269,P=0.030)、SII高表达(HR=1.854,95%CI:1.120~2.568,P=0.009)是影响NSCLC患者生存预后的独立危险因素。结论 SII高表达是NSCLC患者免疫治疗预后预测的独立危险因素,检测NSCLC患者免疫治疗前SII是新的预后判断的外周血指标。

Objective To study the predictive value of systemic immune-inflammation index(SII)in the immune therapy of non-small cell lung cancer(NSCLC)patients.Methods The clinical data of 88 patients with NSCLC who received immunotherapy in our hospital from January 2019 to December 2019 were selected.The timedependent receiver operating curve was used to determine the optimal cut-off value of SII.The clinical therapeutic effects of the two groups and their relationship of SII with clinicopathological characteristics were statistically analyzed.Kaplan-Meier survival analysis(Log-Rank test)were used to analyze the difference in survival prognosis of patients with different SII levels.Univariate and multivariate COX regression analysis were used to analyze risk factors affecting the survival prognosis of NSCLC patients receiving immunotherapy.Results The best cut-off value of SII was 423.SII was related to the clinical stage of NSCLC patients(all P < 0.05).The disease control rate in the high SII group was 23.26%(10/43),which was significantly lower than 53.33%(24/45)in the low SII group(χ2= 8.390,P = 0.004).The 3-year overall survival rate of the high SII group was 18.60%(8/43),which was significantly lower than that of the low SII group,51.11%(23/45)(Log-rank χ2= 6.721,P = 0.000);the median overall survival of the high SII group was was 16.25(9.20 ~ 19.36)months,which was significantly lower than22.23(14.57 ~ 26.92)months in the low SII group(U = 4.886,P = 0.000).Tumor stage IV(HR = 1.637,95%CI:1.054 ~ 2.269,P = 0.030),high expression of SII(HR = 1.854,95%CI:1.120 ~ 2.568,P = 0.009)were independent risk factors affecting the survival prognosis of NSCLC patients.Conclusion SII is an independent factor predicting the prognosis of NSCLC patients after immunotherapy.The detection of SII before immunotherapy in NSCLC patients is a new peripheral blood index for prognostic judgment.