预后营养指数、白球比在晚期非小细胞肺癌免疫治疗疗效评估中的价值

The value of prognostic nutritional index and albumin to globulin ratio in the evaluation of the efficacy of immunotherapy for advanced non-small cell lung cancer

目的探讨预后营养指数(Prognostic nutritional index,PNI)、白球比(Albumin to globulin ratio,AGR)在晚期非小细胞肺癌(Non-small cell lung cancer,NSCLC)免疫治疗疗效评估中的价值。方法回顾性收集2018年1月~2022年1月符合本研究纳入与排除标准的晚期NSCLC患者的临床资料,以治疗前PNI、AGR为检验变量,疾病控制情况为状态变量,绘制受试者工作特征曲线(Receiver operating characteristic curve,ROC),以ROC曲线确定PNI、AGR最佳截断值,将PNI、AGR按截断值分为高PNI(H-PNI)组,低PNI(L-PNI)组;高AGR(H-AGR)组,低AGR(L-AGR)组,分析各组患者免疫疗效及预后的差异。结果H-PNI组患者的ORR(31.9%)高于L-PNI组(13.6%),差异无统计学意义(P=0.107),H-PNI组患者的DCR(59.6%)高于L-PNI组(22.7%),差异具有统计学意义(P=0.004)。H-AGR组患者的ORR(42.4%)高于L-AGR组(11.1%),差异有统计学意义(P=0.003),H-AGR组患者的DCR(72.7%)高于L-AGR组(25.0%),差异具有统计学意义(P=0.000)。PNI、AGR与PFS的Kaplan-Meier单因素生存分析结果显示:H-PNI组患者未达到中位PFS,L-PNI组患者中位PFS为6.05个月,差异具有统计学意义(P=0.000)。H-AGR组患者未达到中位PFS,L-AGR组患者中位PFS为6.24个月,差异具有统计学意义(P=0.000)。将PNI、AGR纳入COX多因素回归分析提示PNI、AGR是影响晚期NSCLC患者PFS的独立预测因素。结论治疗前PNI、AGR可以作为晚期NSCLC免疫治疗预后的独立预测因素。

Objective To explore the value of prognostic nutritional index and albumin to globulin ratio in evaluating the efficacy of immunotherapy for advanced non-small cell lung cancer(NSCLC).Methods The clinical data of patients with advanced NSCLC who met the inclusion and exclusion criteria of this study from Jan 2018 to Jan 2022 were retrospectively collected.PNI and AGR before treatment were used as test variables,and disease control was used as state variables.The receiver operating characteristic(ROC)curve of the subjects was drawn,and the best cutoff value was determined by ROC curve method.PNI and AGR were divided into four groups according to the cutoff value:high PNI(L-PNI)group and low PNI(L-PNI)group,high AGR(H-AGR)group and low AGR(L-AGR)group.The differences of immune efficacy and prognosis were analyzed.Results The ORR of H-PNI group(31.9%)was higher than that of L-PNI group(13.6%),the difference was not statistically significant(P=0.107).The DCR of H-PNI group(59.6%)was higher than that of L-PNI group(22.7%),the difference was statistically significant(P=0.004).The ORR of H-AGR group(42.4%)was higher than that of L-AGR group(11.1%),with a statistically significant difference(P=0.003).The DCR of H-AGR group(72.7%)was higher than that of L-AGR group(25.0%),with a statistically significant difference(P=0.000).The Kaplan-Meier univariate survival analysis results of PNI,AGR and PFS showed that the median PFS of patients in H-PNI group was not reached,while the median PFS of patients in L-PNI group was 6.05 months.The difference was statistically significant(P=0.000).The median PFS of patients in H-AGR group was not reached,while the median PFS of patients in L-AGR group was 6.24 months.The difference was statistically significant(P=0.000).The inclusion of PNI and AGR in COX multivariate regression analysis suggested that PNI and AGR were independent predictors of PFS.Conclusion The serum level of PNI and AGR can be used as predictive marker significantly related to better DCR and PFS.