背景:免疫检查点抑制剂(ICI)是肿瘤治疗的重大突破。它可以激活患者自身的免疫系统,发挥抗肿瘤的作用,但并非所有患者都能从中受益。目前,目前尚缺乏有效的生物标志物来指导临床应用。全身免疫炎症(SII)指数反映了患者的全身炎症状态和免疫状态。预后营养指数(PNI)可用于评估患者的免疫状态。因此,SII和PNI指数对预测免疫治疗的疗效和预后有一定的价值。但仍缺乏相关研究。我们的研究目的是探讨SII和PNI指数对免疫治疗疗效和预后的影响。
方法:回顾性收集2016年11月至2021年10月在河北医科大学第四医院接受ICIs治疗的1935例患者。435例符合纳入标准且不符合排除标准的患者。成像数据,在ICIs治疗前1周内收集每位患者的血液结果.中性粒细胞淋巴细胞比率(NLR),血小板淋巴细胞比率(PLR),单核细胞淋巴细胞比率(MLR),PNI,全身炎症反应指数(SIRI),计算中性粒细胞-嗜酸性粒细胞比值(NER).对患者进行住院病人随访,门诊复查和电话联系,并记录疗效评价和生存状况。随访截止日期:2021年1月。采用SPSS-24.0软件进行统计分析。
结果:在接受ICI治疗的435名患者中,分别评估了61,236例和138例患者的部分反应(PR),稳定疾病(SD)和进行性疾病(PD)。总有效率(ORR)和疾病控制率(DCR)分别为14.0%和68.3%,分别。中位无进展生存期(mPFS)为4.0个月,该队列的总生存期(mOS)为6.8个月。多变量分析表明,SIRI(危险比,HR=1.304,P=0.014),PNI(HR=0.771,P=0.019),前白蛋白(PAB)(HR=0.596,P=0.001),PNI(HR=0.657,P=0.008)是影响PFS和OS的独立危险因素,分别。
结论:ICI治疗前高SIRI值和低PNI值的患者PFS较短。PNI值越高的患者预后越好。因此,血液学指标可能成为免疫治疗的预测因子。
BACKGROUND: Immunocheckpoint inhibitor(ICI) is a major breakthrough in tumor treatment. It can activate the patient\'s own immune system and play an anti-tumor role, but not all patients can benefit from it. At present, there is still a lack of effective biomarkers to guide clinical application. The systemic immune inflammation(SII) index reflects the systemic inflammatory state and immune state of patients. Prognostic nutrition index(PNI) can be used to evaluate immune status of patients. Therefore, SII and PNI indexes may have some value in predicting the efficacy and prognosis of immunotherapy, but there is still a lack of relevant research. The purpose of our
study was to explore the influence of SII and PNI index on the efficacy and prognosis of immunotherapy.
METHODS: A total of 1935 patients treated with ICIs treatment in the Fourth Hospital of Hebei Medical University from November 2016 to October 2021 were retrospectively collected. 435 patients who met the inclusion criteria and did not meet the exclusion criteria. The imaging data, blood results of each patient were collected within 1 week before ICIs treatment. The neutrophil lymphocyte ratio(NLR), platelet lymphocyte ratio(PLR), monocyte lymphocyte ratio(MLR), PNI,systemic inflammatory response index(SIRI),neutrophil-eosinophil ratio(NER) was calculated. The patients were followed up by in-patient, out-patient reexamination and telephone contact, and the efficacy evaluation and survival status were recorded. The deadline of follow-up: January 2021. SPSS-24.0 software was employed for statistical analysis.
RESULTS: Among the 435 patients receiving ICI treatment, 61,236 and 138 patients were evaluated respectively as partial response (PR), stable disease (SD) and progressive disease (PD). The overall response rate(ORR) and disease control rate (DCR) of this cohort were 14.0% and 68.3%, respectively. Median progression-free survival (mPFS) is 4.0 months, The overall survival (mOS) of this cohort is 6.8 months. Multivariate analysis showed that SIRI(Hazard Ratio, HR = 1.304, P = 0.014), PNI (HR = 0.771, P = 0.019), prealbumin (PAB) (HR = 0.596, P = 0.001), and PNI(HR = 0.657, P = 0.008) were independent risk factors for PFS and OS, respectively.
CONCLUSIONS: Patients with high SIRI value and low PNI value before ICI treatment have shorter PFS. Patients with higher PNI value have better prognosis. Therefore, hematological indicators may become predictors of immunotherapy.