系统免疫炎症指数与外周血相关指标对进展期非小细胞肺癌患者预后的预测价值  

The predictive value of systemic immune inflammation index and peripheral blood related indicators on the prognosis of patients with advanced non-small cell lung cancer

作　　者：段惠娟 李希 党傲 赖雪梅 张家春 DUAN Hui-juan;LI Xi;DANG Ao;LAI Xue-me;ZHANG Jia-chun(Donghong Respiratory Oncology Department,Chengdu Sixth People′s Hospital,Chengdu 610041,China)

机构地区：[1]成都市第六人民医院东虹呼吸肿瘤科,四川成都610041

出　　处：《实用医院临床杂志》2023年第5期74-78,共5页Practical Journal of Clinical Medicine

基　　金：成都市卫生健康委员会科研基金资助项目(编号:2020124)。

摘　　要：目的 探讨系统免疫炎症指数(SII)与外周血相关指标[血红蛋白(Hb)、中性粒细胞-淋巴细胞比值(NLR)]对进展期非小细胞肺癌(NSCLC)患者免疫治疗疗效及预后的预测价值。方法 在我院进行PD-1单抗免疫治疗的120例Ⅲb期和Ⅳ期的NSCLC患者,检测和计算出患者接受治疗6周后的Hb水平及SII指数、NLR值,随访统计患者的无进展生存期(PFS)和总生存期(OS),根据随访期间是否出现死亡事件分为死亡组(n=64)和生存组(n=56),比较两组SII指数、NLR值及Hb水平,分析三种指标对NSCLC患者预后的预测效能,并分析影响预后的危险因素。结果 120例患者治疗效果:疾病进展43例(35.83%)、疾病稳定46例(38.33%)、部分缓解31例(25.83%)。患者PFS为(6.60±1.03)个月,OS为(17.36±4.38)个月;死亡组SII指数、NLR显著高于生存组,Hb显著低于生存组(P<0.05);ROC曲线分析显示SII指数、NLR及Hb的临界值分别为945.81、3.72、110.00 g;曲线面积(AUC)分别为0.742、0.784、0.738;预后预测的敏感度和特异度为79.03%、79.84%,82.34%、80.13%,75.68%、82.30%。COX多因素分析显示免疫治疗6周后的高SII指数(SII>945.81)、高NLR值(NLR>3.72)及低Hb水平(Hb<115.00 g)是NSCLC患者PFS的独立危险因素(P<0.05);ECOG体质状态评分<1分、转移病灶数>3个及免疫治疗6周后的高SII指数(SII>945.81)、高NLR值(NLR>3.72)、低Hb水平(Hb<115.00 g)是NSCLC患者OS的独立危险因素(P<0.05)。结论 SII、NLR及Hb对进展期NSCLC患者的免疫治疗疗效和预后情况均有良好的预测价值,可作为进展期NSCLC患者对免疫治疗产生应答的生物标志物,有利于指导患者临床免疫治疗。Objective To explore the predictive value of systemic immune inflammatory index(SII)and peripheral blood related indexes such as hemoglobin(Hb)and neutrophil lymphocyte ratio(NLR)on the efficacy and prognosis of immunotherapy in patients with advanced non-small cell lung cancer(NSCLC).Methods One hundred and twenty patients with NSCLC in stage IIIb and IV who were treated with PD-1 monoclonal antibody in our hospital were selected.The Hb level,SII index and NLR value of the patients after 6 weeks of treatment were detected and calculated.The progression-free survival(PFS)and total survival(OS)of the patients were followed up and counted.The patients were divided into a death group(n=64)and a survival group(n=56)according to whether there were death events during the follow-up period.The SII index,NLR value and Hb level were compared between the two groups.The predictive efficacy of the three indicators on the prognosis of patients with NSCLC was analyzed.The risk factors for the prognosis were also analyzed.Results The curative effect of the 120 patients was as follows:43 cases(35.83%)with disease progression,46 cases(38.33%)with disease stability and 31 cases(25.83%)with partial remission.The patient′s PFS was(6.60±1.03)months and OS was(17.36±4.38)months.The SII index and NLR value of the death group were significantly higher than those of the survival group,and the Hb level of the death group was significantly lower than that in the survival group(P<0.05).ROC curve analysis showed that the critical values of SII index,NLR and Hb were 945.81,3.72 and 110.00 g,respectively,and the curve area(AUC)was 0.742,0.784 and 0.738,respectively.The sensitivity of prognosis prediction was 79.03%,79.84%and 82.34%,respectively.The specificity prognosis prediction was 80.13%,75.68%and 82.30%,respectively.COX multivariate analysis showed that high SII index(SII>945.81),high NLR value(NLR>3.72)and low Hb level(Hb<115.00 g)were independent risk factors for PFS in the patients with NSCLC(P<0.05).Eastern Cooperative Oncology Gr

关 键 词：进展期非小细胞肺癌 系统免疫炎症指数 外周血相关指标 疗效 预后 

分 类 号：R734[医药卫生—肿瘤]