肌肉减少症在进展期非小细胞肺癌免疫疗效中的预测价值  

Predictive value of sarcopenia in the eficacy of immunotherapy for advanced non-small cell lung cancer

作　　者：张璐瑶 汪丽钰 俞铭扬 郭芬 冯颖 Zhang Laryao;Wang Liyu;Yu Mingyang;Guo Fen;Feng Ying(Depurtment of Oncology,the Affiliated Suzhou Hopital of Nanjing Medical University,Suzhou Municeipal Hospital,Gusu School,Nanjing Medical University,Suzhou 215000,Jiangsu,China Abstract:Objective To investigate the value of sarcopenia in predicting the prog)

机构地区：[1]南京医科大学姑苏学院,南京医科大学附属苏州医院,苏州市立医院肿瘤内科,江苏苏州215000

出　　处：《肿瘤代谢与营养电子杂志》2023年第3期362-369,共8页Electronic Journal of Metabolism and Nutrition of Cancer

摘　　要：目的探讨肌肉减少症对预测使用程序性死亡受体1/程序性死亡配体1(PD-1/PD-L1)免疫检查点抑制剂(ICIs)治疗的局部晚期或转移性非小细胞肺癌(NSCLC)患者预后以及免疫相关性不良反应(irAEs)发生率的应用价值。方法本研究为回顾性研究。选取2019年5月1日至2022年4月30日期间就诊于南京医科大学附属苏州医院接受一线、二线或三线ICIs治疗的82例局部晚期或转移性NSCLC患者。根据骨骼肌质量指数(SMI)将患者分为肌肉减少症组和非肌肉减少症组,收集患者的SMI、血常规、生化、治疗反应等随访数据,通过Kaplan-Meier曲线、Cox比例风险回归模型、Mann-Whitney U检验、卡方检验、单多因素Logistics回归分析、独立t检验等方法评估肌肉减少症对预测局部晚期或转移性NSCLC患者接受PD-1/PD-L1抑制剂治疗疗效的价值。结果82例入选患者的中位无进展生存(PFS)期为8.5个月(范围0.7~40个月,95%CI=8.16~11.47)。通过Kaplan-Meier曲线分析发现,肌肉减少症组的PFS期明显短于非肌肉减少症组(5.8个月比10个月,P=0.017)。通过Mann-Whitney U检验发现,甘油三酯、腰围、Karnofsky功能状态(KPS)评分、营养风险筛查2002(NRS2002)量表评分在两组患者中有明显差异(分别为P=0.022、0.004、0.009、0.007),两组的客观缓解率(ORR)有显著差异(5.56%比39.13%,P=0.001)。根据患者是否发生疾病缓解,将患者分为完全缓解+部分缓解组(即OR组)和疾病稳定+疾病进展组(即非OR组),通过独立t检验发现,OR组和非OR组的SMI有显著差异[(50.24±8.48)cm^(2)/m^(2)比(45.09±9.82)cm^(2)/m^(2),P=0.0408],肌肉减少症组ir AEs发生率明显高于非肌肉减少症组(P=0.015),且ir AEs与体质指数(BMI)、白球比(A/G)、甘油三酯、腰围、三线治疗、肌肉减少症相关,其中A/G和三线治疗是独立危险因素。结论肌肉减少症可作为预测接受PD-1/PD-L1治疗的局部晚期或转移性NSCLC患者预后的敏感指标,能有�nosis of advanced NSCLC patients using PD1/PD-L1 immune checkpoint inhibitors(ICIs)and the incidence of inmune-related adverse events(irAEs).Method A total of 82 eligible patients with advanced NSCLC treated by PD1/PD-L1 inhibitors in first-line,second-line,or third-line were erolled from May 1,2019 to April 30,2022,at the afiliated Suzhou Hospital of Nanjing Medical University.Patients were divided into saropenia group and non-saroopenia group based on SMI.All the fllow-up data,including skeletal musce index(SMI),blood routine examination,blood biochemical test,and treatment response,were collected in the electronie medical record system.Through Kaplan-Meier,Cox survival analysis,the Mann-Whitney U test,the chi square test,univariate and muliple Logistie regression analysis,and an independent t-est,we evaluated the value of sarcopenia in predicting the curative effect of ICI inhibitors for patients with adwanced NSCLC.Result The median progression free survival(PFS)of all 82 enolled patients was 8.5 months(range:0.7-40 months,95%CI=8.16-11.47).The Kaplan-Meier analysis revealed that patients with sarcopenia had a significantly shorter PFS than those without sarcopenia(5.8vs10 months,P=0.017).Mann-Whitney U test showed that triglyceide,waist circunference,nutritional risk screening 2002(NRS 2002)grade and Kamofsky performance score(KPS)were significantly different between the two groups(P=0.022,0.004,0.009,0.007,respectively).Patients were gouped according to whether they had an olbjective response,and it was found by independent t-test.There was a significant difference in ORR between the sarcopenia group and the nom-saropenia group(5.56%vs39.13%,P=0.001).Based on the ocurrence of disease remission,patients were categorized into a group of complete remission and partial remission(referred to as the OR goup)and a group of stable dsease and disease progression(referred to a the non-OR group).An independent t-test revealed a sigificant difference in SMI between the OR group and the non-OR group[(50.24±8.48)cm^(2)/

关 键 词：非小细胞肺癌 肌肉减少症 免疫检查点抑制剂 无进展生存期 免疫相关性不良反应 

分 类 号：R685[医药卫生—骨科学] R734.2[医药卫生—外科学]