血清离子对免疫检查点抑制剂治疗非小细胞肺癌疗效影响分析  

The influence of serum ions on the efficacy of immune checkpoint inhibitor in the treatment of non-small cell lung cancer

作　　者：郑清月 闫春良[1] 赵秋红[1] 薛旗山[1] 刘亚峰[1] 马丽云 ZHENG Qingyue;YAN Chunliang;ZHAO Qiuhong;XUE Qishan;LIU Yafeng;MA Liyun(Department of Respiratory and Critical Care Medicine,Beijing Aerospace General Hospital,Beijing 1ooo76,China)

机构地区：[1]北京航天总医院呼吸与危重症医学科,北京100076

出　　处：《中华肿瘤防治杂志》2024年第17期1067-1072,共6页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的探讨血清钾、钠、氯离子浓度对接受免疫检查点抑制剂(ICI)治疗的非小细胞肺癌(NSCLC)患者疗效影响。方法回顾性分析2017-06-01-2023-06-01在北京航天总医院行ICI单药或联合治疗的149例Ⅲ期或Ⅳ期NSCLC患者临床资料,根据疗效分为客观缓解[完全缓解(CR)+部分缓解(PR)]组(51例)和非客观缓解[疾病稳定(SD)+疾病进展(PD)]组(98例)以及疾病控制(CR+PR+SD)组(105例)和PD组(44例),采用独立样本t检验比较组间治疗前后血清钾、钠、氯离子差异。Cox单因素和多因素比例风险回归模型分析无进展生存期(PFS)和总生存期(OS)相关因素。结果CR+PR组和SD+PD组,组间各离子指标差异无统计学意义。与PD组相比,CR+PR+SD组pre-Na^(+)(141.8±4.4 vs 139.9±5.6;t=2.289,P=0.024)、post-Na^(+)(141.0±4.6 vs 139.0±5.5;t=2.152,P=0.035)、post-Cl^(-)(103.2±3.1 vs 101.6±4.4;t=2.285,P=0.026)和post-Na^(+)+Cl^(-)(244.3±6.7 vs 240.6±9.3;t=2.706,P=0.008)较高。Cox单因素回归分析结果显示,pre-Na^(+)<137 mmol/L[HR(95%CI)为1.591(1.027~2.464),P=0.038]和pre-Cl^(-)<101 mmol/L[HR(95%CI)为1.571(1.056~2.336),P=0.026]是较短PFS的危险因素;pre-Na^(+)<137 mmol/L[HR(95%CI)为1.971(1.170~3.321),P=0.011]、(pre-Na^(+)+Cl^(-))<241 mmol/L[HR(95%CI)为1.703(1.070~2.713),P=0.025]和post-Na^(+)<137 mmol/L[HR(95%CI)为1.687(1.061~2.684),P=0.027]是较短OS的危险因素。Cox多因素回归分析结果提示post-Na^(+)<137 mmol/L[HR(95%CI)为1.632(1.010~2.639),P=0.046]是较短OS的独立危险因素。结论接受ICI治疗的NSCLC患者中较高血清钠离子和氯离子浓度预示着较好的预后结果。Objective To investigate the effects of serum potassium,sodium and chloride ion concentrations on the efficacy of immune checkpoint inhibitors(ICIs)in patients with non-small cell lung cancer(NSCLC).Methods The clinical data of 149 patients with stage II or IV NSCLC who received ICI monotherapy or combination therapy from June 1,2017,to June 1,2023 in Beijing Aerospace General Hospital were retrospectively analyzed.They were divided into objective response[complete response(CR)+partial response(PR)]group(n=51),non-objective response[stable disease(SD)+pro-gressive disease(PD)]group(n=98),disease control(CR+PR+SD)group(n=105),and PD group(n=44)based on efficacy.Independent sample t-test was used to compare the differences between groups in serum potassium,sodium,chlo-ride concentration before and after treatment.Factors related to progression-free survival(PFS)and overall survival(OS)were analyzed using Cox univariate and multifactorial proportional risk regression models.Results There was no signifi-cant difference in ion indexes between CR+PR group and SD+PD group.Compared with PD group,CR+PR+SD group had higherpre-Na^(+)(141.8±4.4us139.9±5.6;t=2.289,P=0.024),post-Na^(+)(141.0±4.6vs139.0±5.5;t=2.152,P=0.035),post-Cl^(-)(103.2±3.1vs101.6±4.4;t=2.285,P=0.026)andpost-Na^(+)+Cl^(-)(244.3±6.7us240.6±9.3;t=2.706,P=0.008).Cox univariate regression analysis showed that pre-Na^(+)<137 mmol/L[HR(95%CI)1.591(1.027-2.464),P=0.038]and pre-Cl^(-)<101mmol/L[HR(95%CI)1.571(1.056-2.336),P=0.026]were risk factors for short PFS,and pre-Na^(+)<137 mmol/L[HR(95%CI)1.971(1.170-3.321),P=0.011],pre-Na^(+)+Cl^(-)<241 mmol/L[HR(95%CI)1.703(1.070-2.713),P=0.025],post-Na^(+)<137 mmol/L[HR(95%CI)1.687(1.061-2.684),P=0.027]were risk factors for shorter OS.Cox multivariate regression analysis indicated that post-Na^(+)<137 mmol/L[HR(95%CI)1.632(1.010-2.639),P=0.046]was an independent risk factor for shorter OS.Conclusion Higher serum concentrations of sodium and chloride in NSCLC patients treated with immune checkpoint inhibitors are

关 键 词：免疫检查点抑制剂 血清离子 非小细胞肺癌 预后 

分 类 号：R734.2[医药卫生—肿瘤]