外周免疫评分对非小细胞肺癌免疫治疗疗效的影响及相关预测模型的构建  

Influence of peripheral immune score on the immunotherapy efficacy of non-small cell lung cancer and the construction of related prediction model

作　　者：何冠锋 林慧 林春雨 曾煜 宋楚歌 黄志发 HE Guanfeng;LIN Hui;LIN Chunyu;ZENG Yu;SONG Chuge;HUANG Zhifa(Respiratory and Critical Care Medicine SectionⅡ,the Second Affiliated Hospital of Guangdong Medical University,Zhanjiang,Guangdong 524000,China;Health Management Center of the Second Affiliated Hospital of Guangdong Medical University,Zhanjiang,Guangdong 524000,China;Guangdong Medical University,Zhanjiang,Guangdong 524023,China)

机构地区：[1]广东医科大学附属第二医院呼吸与危重症医学科二区,广东湛江524000 [2]广东医科大学附属第二医院健康管理中心,广东湛江524000 [3]广东医科大学,广东湛江524023

出　　处：《国际检验医学杂志》2023年第9期1070-1074,1079,共6页International Journal of Laboratory Medicine

基　　金：广东省湛江市科技计划项目(2021A1003-2)。

摘　　要：目的探讨外周免疫评分对非小细胞肺癌(NSCLC)患者免疫治疗疗效的影响,并构建治疗疗效的评估模型。方法选取2018年3月至2021年9月于该院接受免疫治疗的190例NSCLC患者为研究对象。根据外周免疫评分将其分为免疫正常组(135例)、免疫低下组(25例)、免疫亢进组(30例),根据治疗疗效将患者分为有效组和无效组。建立Nomogram模型,采用受试者工作特征(ROC)曲线及内部数据验证其性能,采用Logistic回归模型分析患者治疗疗效的影响因素。结果与免疫低下组及免疫亢进组相比,免疫正常组总有效率及疾病控制率均较高(P<0.05);与无效组相比,有效组吸烟、骨转移、TNM分期处于Ⅲ~Ⅳ期、免疫外周评分>0或<0分者比例,以及中性粒细胞/淋巴细胞比值(NLR)、血小板/淋巴细胞比值(PLR)较低(P<0.05);ROC曲线分析显示,NLR、PLR预测免疫治疗疗效的曲线下面积(AUC)分别为0.662(95%CI:0.590~0.729)、0.721(95%CI:0.651~0.783),cut-off值分别为4.23、195.67;吸烟、骨转移、TNM分期、外周免疫评分、NLR、PLR均是免疫治疗疗效的影响因素(P<0.05);Nomogram模型预测患者治疗疗效的C-index为0.727(95%CI:0.684~0.810),Nomogram模型预测患者治疗疗效的风险阈值>0.07。结论免疫外周评分正常NSCLC患者免疫治疗疗效较好,构建的Nomogram模型可较好地预测患者治疗疗效。Objective To investigate the effect of peripheral immune score on the immunotherapy efficacy in patients with non-small cell lung cancer(NSCLC),and to construct an evaluation model for therapeutic efficacy.Methods A total of 190 patients with NSCLC who received immunotherapy in the hospital from March 2018 to September 2021 were selected as the study objects.According to peripheral immune scores,the patients were divided into normal immune group(135 cases),immunocompromised group(25 cases)and hyperimmune group(30 cases),and the patients were divided into effective group and ineffective group according to therapeutic efficacy.A Nomogram model was established to verify the clinical efficacy by receiver operating characteristic(ROC)curve and internal data,and the influencing factors were analyzed by Logistic regression model.Results Compared with immunocompromised group and hyperimmune group,the total effective rate and disease control rate of immune normal group were higher(P<0.05).Compared with the ineffective group,the proportion of smokers,bone metastases,TNM stage in stageⅢtoⅣ,peripheral immune score>0 or<0,NLR and PLR in the effective group were lower(P<0.05).ROC curve analysis showed that the area under the curve(AUC)of NLR and PLR to predict the efficacy of immunotherapy were 0.662(95%CI:0.590-0.729)and 0.721(95%CI:0.651-0.783)respectively.The cut-off values were 4.23 and 195.67,respectively.Smoking,bone metastasis,TNM stage,peripheral immune score,NLR and PLR were all influencing factors of immunotherapy efficacy(P<0.05).The risk C-index of Nomogram model predicting the efficacy of treatment was 0.727(95%CI:0.684-0.810).The risk threshold of Nomog ram model predicting the curative effect was over 0.07.Conclusion Patients with normal peripheral immune scores shows better immunotherapy efficacy and the established Nomogram model could better predict the therapeutic efficacy of patients.

关 键 词：非小细胞肺癌 外周免疫评分 免疫治疗 Nomogram模型 

分 类 号：R730.51[医药卫生—肿瘤] R734.2[医药卫生—临床医学]