外周血炎症指标对结直肠癌肺转移患者免疫联合治疗的疗效预测与预后分析

Prediction and Prognostic Analysis of Peripheral Blood Inflammatory Markers on the Efficacy of Combined Immunotherapy in Patients with Colorectal Cancer Lung Metastases

摘要: 目的：探讨经免疫检查点抑制剂(ICIs)联合酪氨酸激酶抑制剂(TKIs)治疗的结直肠癌肺转移患者中，外周血炎症指标及淋巴细胞计数与预后的相关性。方法：回顾性收集2020年10月至2025年10月于安徽医科大学附属医院总计86例结直肠癌伴肺转移患者；所有患者均接受ICIs联合酪氨酸激酶抑制剂治疗。采集治疗前外周血指标，计算NLR、PLR、LMR、SII，并记录PBLC。采用Kaplan-Meier法及Log-rank检验进行生存分析，通过Cox比例风险回归模型评估各指标与PFS和OS的独立关联。结果：单因素分析显示NLR、PLR、SII、PBLC与PFS和OS显著相关(P < 0.05)。多因素分析表明，高水平NLR、PLR及SII是患者PFS与OS的独立危险因素(P < 0.05)，而PBLC ≥ 1.1 × 10⁹/L为保护因素。高水平LMR仅与OS延长独立相关。结论：基线NLR、PLR、SII、LMR和PBLC可作为结直肠癌肺转移患者接受ICIs联合酪氨酸激酶抑制剂治疗的潜在预后生物标志物，这对个体化治疗策略制定具有参考价值。

Abstract: Objective: This study aimed to investigate the correlation between peripheral blood inflammatory markers, lymphocyte counts and prognosis in patients with colorectal cancer (CRC) lung metastasis receiving combined therapy of immune checkpoint inhibitors (ICIs) and tyrosine kinase inhibitors (TKIs). Methods: A retrospective cohort study was conducted on 86 patients with CRC lung metastasis who received ICI-TKI combination therapy at the Affiliated Hospital of Anhui Medical University from October 2020 to October 2025. Baseline peripheral blood samples were collected prior to treatment. Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and systemic immune-inflammation index (SII) were calculated, and peripheral blood lymphocyte count (PBLC) was recorded. Survival analyses were performed using the Kaplan-Meier method with Log-rank test for comparison. Cox proportional hazards regression models were constructed to evaluate the independent prognostic value of each marker for progression-free survival (PFS) and overall survival (OS). Results: Univariate survival analysis revealed that NLR, PLR, SII, and PBLC were significantly associated with both PFS and OS (all P < 0.05). Multivariate Cox regression analysis demonstrated that elevated NLR, PLR, and SII were independent risk factors for shorter PFS and OS (all P < 0.05), whereas a PBLC ≥ 1.1 × 10⁹/L served as an independent protective factor. Notably, a high LMR was independently correlated with prolonged OS but not PFS. Conclusion: Baseline levels of NLR, PLR, SII, LMR, and PBLC hold promise as prognostic biomarkers for patients with CRC lung metastasis treated with ICI-TKI combination therapy. These findings may provide valuable insights for guiding the development of individualized treatment strategies.