全身免疫炎症指数对原发性肝癌患者免疫检查点抑制剂治疗相关不良反应的预测价值

The predictive value of systemic immune-inflammation index for immune checkpoint inhibitor treatment-related adverse reactions in patients with primary liver cancer

目的探讨全身免疫炎症指数(systemic-immune inflammation index,SII)对原发性肝癌(primary liver cancer,PLC)患者免疫检查点抑制剂(immune checkpoint inhibitors,ICIs)治疗相关不良反应的预测价值。方法选取2022年1月至2023年10月期间收治的接受ICIs治疗的162例PLC患者,按照是否发生免疫相关不良反应(immune-related adverse events,irAEs)分为irAEs组和非irAEs组。收集并比较两组的临床资料,采用多因素Logistic回归分析接受ICIs治疗的PLC患者发生irAEs的影响因素。绘制受试者工作特征(receiver operating characteristic,ROC)曲线评价SII对ICIs治疗后的PLC患者发生irAEs的预测价值。结果162例接受ICIs治疗的PLC患者中发生irAEs 77例(47.53%),其中单一性irAEs 74例,以内分泌毒性最常见(13.58%);多重性irAEs 3例,以肝脏毒性结合皮肤毒性最常见(1.23%)。多因素Logistic回归分析结果显示,既往自身免疫疾病史、IL-6、SII是影响接受ICIs治疗的PLC患者发生irAEs的独立危险因素(P<0.05)。ROC曲线分析结果显示:IL-6、SII预测接受ICIs治疗的PLC患者发生irAEs的曲线下面积分别为0.693(95%CI:0.589~0.797)、0.816(95%CI:0.732~0.900)。最佳截断值为1336.8×10^(9)/L时,SII预测灵敏度和特异度分别为87.76%和63.65%。结论SII预测接受ICIs治疗的PLC患者发生irAEs具有良好价值,且是影响接受ICIs治疗的PLC患者发生irAEs的独立危险因素。

Objective To investigate the predictive value of systemic immune-inflammation index(SIl)for the treatment-related adverse reactions of immune checkpoint inhibitors(ICIs)in patients with primary liver cancer(PLC).Methods A total of 162 patients with PLC who received ICIs treatment from January 2022 to October 2023 were selected and divided into immune-related adverse events(irAEs)group and non-irAEs group according to whether irAEs occurred.The clinical data of the two groups were collected and compared.Multivariate Logistic regression analysis was used to analyze the influencing factors of irAEs in the PLC patients treated with ICIs.The receiver operating characteristic(ROC)curve was drawn to evaluate the predictive value of SII for irAEs in the PLC patients after ICIs treatment.Results Among the 162 PLC patients treated with ICIs,there were 77 cases of irAEs,accounting for 47.53%,of which 74 cases were single irAEs,and endocrine toxicity was the most common(13.58%).There were 3 cases of multiple irAEs,and hepatotoxicity combined with skin toxicity was the most common(1.23%).Multivariate Logistic regression analysis showed that previous history of autoimmune diseases,IL-6 and SII were independent risk factors for irAEs in PLC patients treated with ICIs(P<0.05).The results of ROC curve analysis showed that the area under the curve of IL-6 and SII in predicting irAEs in PLC patients treated with ICIs was 0.693(95%CI:0.589-0.797)and 0.816(95%CI:0.732-0.900),respectively.The optimal cutoff value of SII was 1336.8×10^(9)/L,and the sensitivity was 87.76%and the specificity was 63.65%.ConclusionSSII has a good value in predicting irAEs in PLC patients treated with ICIs,and is an independent risk factor.