LIPI及iSEND免疫评分在晚期非小细胞肺癌免疫治疗中的预测价值分析  

Predictive Value of LIPI and iSEND Immune Scoring System in Immunotherapy of Advanced Non-small Cell Lung Cancer

作　　者：罗怡颖 王新娟 王一博 张国俊[1] Yiying LUO;Xinjuan WANG;Yibo WANG;Guojun ZHANG(Department of Pulmonary and Critical Care Medicine,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第一附属医院呼吸与危重症科,郑州450000

出　　处：《中国肺癌杂志》2022年第11期803-810,共8页Chinese Journal of Lung Cancer

基　　金：国家自然科学基金项目(No.81874042)资助。

摘　　要：背景与目的本研究回顾性分析了肺癌免疫治疗预后指数(lung immune prognostic index,LIPI)及iSEND免疫评分系统在中国晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)患者免疫治疗中的应用价值,以寻找指导临床制定NSCLC治疗方案的新指标。方法回顾性分析178例应用免疫治疗的晚期NSCLC患者的临床资料。对患者分别进行LIPI及iSEND免疫评分,绘制受试者工作特征曲线(receiver operating characteristic curve,ROC)并比较两者对客观缓解率(objective response rate,ORR)、疾病控制率(disease control rate,DCR)、无进展生存期(progression free survival,PFS)的预测价值。应用Kaplan-Meier方法进行生存分析,单因素和多因素Cox回归进行各种临床特征与PFS之间的关系分析。结果iSEND免疫评分预测ORR、DCR、PFS的曲线下面积(area under the cuever,AUC)分别为0.616、0.634、0.631;LIPI预测的AUC分别为0.789、0.750、0.732,均大于iSEND免疫评分(P<0.05)。LIPI评分良好、中等、较差组患者的中位PFS分别为9.9个月、6.1个月、3.7个月;iSEND免疫评分良好、中等、较差组患者中位PFS分别为9.9个月、7.0个月、3.5个月,差异均具有统计学意义(P<0.001)。在免疫联合治疗亚组中不同LIPI及不同iSEND免疫评分分组患者中位PFS差异同样具有统计学意义(P<0.05)。Cox回归分析示衍生中性粒细胞与淋巴细胞的比率(derived neutrophil-to-lymphocyte ratio,dNLR)、乳酸脱氢酶(lactic dehydrogenase,LDH)与PFS独立相关(P<0.05)。结论LIPI及iSEND免疫评分系统均能有效预测晚期NSCLC免疫治疗疗效及预后,且LIPI较iSEND免疫评分具有更高的预测价值。Background and objective This study retrospectively analyzed the application value of lung cancer immunotherapy prognostic index(LIPI)and iSEND immune scoring system in advanced non-small cell lung cancer(NSCLC)patients treated with immunotherapy in China,in order to find guidance for clinical development of NSCLC treatment plan.Methods The clinical data of 178 patients with advanced NSCLC treated with immunotherapy were analyzed retrospectively.LIPI and iSEND immune scores were performed,receiver operating characteristic(ROC)curves were drawn,and the predictive values of two models for objective response rate(ORR),disease control rate(DCR),and progression-free survival(PFS)were compared.Kaplan-Meier method was used for survival analysis,and Cox regression analysis method was used for univariate analysis and multivariate analysis.Results The area under the curver(AUC)of ORR,DCR and PFS predicted by iSEND immune score were 0.616,0.634 and 0.631 respectively;LIPI were 0.789,0.750 and 0.732 respectively,which were higher than iSEND immune score(P<0.05).The median PFS of patients in LIPI score groups 0,1 and 2 were 9.9 months,6.1 mon and 3.7 mon respectively;The median PFS of patients with good,moderate and poor iSEND immune scores were 9.9 mon,7.0 mon and 3.5 mon respectively,with statistically significant differences(P<0.001).In the immunotherapy subgroup,the median PFS of patients with different LIPI and iSEND immune scores was also statistically significant.Cox regression analysis showed that the derived neutrophil to lymphocyte ratio(dNLR),lactic dehydrogenase(LDH)and PFS were independently correlated(P<0.05).Conclusion LIPI and iSEND immune scoring system can effectively predict the efficacy and prognosis of advanced NSCLC treated with immunotherapy,and LIPI has higher predictive value than iSEND immune scoring system.

关 键 词：肺肿瘤 肺免疫预后指数 iSEND免疫评分 免疫检查点抑制剂 预后 

分 类 号：R734.2[医药卫生—肿瘤]