基于外周血炎症营养指标对广泛期 小细胞肺癌一线免疫联合化疗 疗效的预测价值研究

Study on the Predictive Value of Peripheral Blood Inflammatory and Nutritional Indices for the Efficacy of First-Line Immunotherapy Combined with Chemotherapy in Extensive-Stage Small Cell Lung Cancer

摘要: 目的：探讨广泛期小细胞肺癌(ES-SCLC)患者接受一线免疫联合化疗的疗效及预后影响因素，评估外周血炎症营养指标的预后预测价值。方法：回顾性分析2020年1月至2024年12月青岛大学附属医院收治的106例ES-SCLC患者临床资料。所有患者均接受依托泊苷联合铂类化疗方案(EP/EC)联合免疫检查点抑制剂(ICIs)作为一线治疗。收集患者基线临床病理特征及实验室指标，计算中性粒细胞与淋巴细胞比值(NLR)、系统免疫炎症指数(SII)、预后营养指数(PNI)、晚期肺癌炎症指数(ALI)及肺免疫预后指数(LIPI)。采用Kaplan-Meier法绘制生存曲线，Log-rank检验比较组间差异，Cox比例风险回归模型分析无进展生存期(PFS)的独立预后因素。结果：全组患者客观缓解率(ORR)为67.92% (72/106)，疾病控制率(DCR)为92.45% (98/106)，中位PFS为5.0个月。多因素Cox回归分析显示，肝转移(HR = 1.689, 95%CI: 1.112~2.564, P = 0.014)、转移器官数目 ≥ 3个(HR = 1.621, 95%CI: 1.042~2.523, P = 0.034)、NLR ≥ 3 (HR = 1.623, 95%CI: 1.052~2.503, P = 0.029)及SII ≥ 655.5 (HR = 1.527, 95%CI: 1.012~2.304, P = 0.042)是PFS的独立不良预后因素；PNI ≥ 45 (HR = 0.616, 95%CI: 0.408~0.930, P = 0.022)和ALI ≥ 18 (HR = 0.636, 95%CI: 0.418~0.967, P = 0.034)是独立保护性因素。安全性方面，3~4级中性粒细胞减少发生率为33.01%，免疫性肺炎发生率为7.55%，无治疗相关死亡事件。结论：免疫联合化疗一线治疗ES-SCLC疗效确切，安全性可控。基线NLR、SII、PNI及ALI等炎症营养指标可有效预测患者预后，肝转移及高转移负荷是独立不良预后因素。上述指标简便易得，可为临床个体化治疗决策提供参考。

Abstract: Objective: To investigate the efficacy and prognostic factors of first-line chemoimmunotherapy in patients with extensive-stage small cell lung cancer (ES-SCLC), and to evaluate the prognostic value of peripheral blood inflammatory and nutritional indices. Methods: Clinical data of 106 ES-SCLC patients treated at the Affiliated Hospital of Qingdao University from March 2021 to December 2024 were retrospectively analyzed. All patients received etoposide plus platinum-based chemotherapy (EP/EC regimen) combined with immune checkpoint inhibitors (ICIs) as first-line treatment. Baseline clinicopathological characteristics and laboratory parameters were collected. The neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), prognostic nutritional index (PNI), advanced lung cancer inflammation index (ALI), and lung immune prognostic index (LIPI) were calculated. Survival curves were plotted using the Kaplan-Meier method, and intergroup differences were compared using the log-rank test. Cox proportional hazards regression models were used to identify independent prognostic factors for progression-free survival (PFS). Results: The objective response rate (ORR) was 67.92% (72/106), and the disease control rate (DCR) was 92.45% (98/106). The median PFS was 5.0 months. Multivariate Cox regression analysis identified liver metastasis (HR = 1.689, 95%CI: 1.112~2.564, P = 0.014), number of metastatic organs ≥3 (HR = 1.621, 95%CI: 1.042~2.523, P = 0.034), NLR ≥ 3 (HR = 1.623, 95%CI: 1.052~2.503, P = 0.029), and SII ≥ 655.5 (HR = 1.527, 95%CI: 1.012~2.304, P = 0.042) as independent adverse prognostic factors for PFS. PNI ≥ 45 (HR = 0.616, 95%CI: 0.408~0.930, P = 0.022) and ALI ≥ 18 (HR = 0.636, 95%CI: 0.418~0.967, P = 0.034) were identified as independent protective factors. Regarding safety, the incidence of grade 3~4 neutropenia was 33.01%, and the incidence of immune-related pneumonitis was 7.55%. No treatment-related deaths occurred. Conclusion: First-line chemoimmunotherapy demonstrates favorable efficacy and manageable safety in ES-SCLC patients. Baseline inflammatory and nutritional indices including NLR, SII, PNI and ALI and can effectively predict patient prognosis. Liver metastasis and high metastatic burden are independent adverse prognostic factors. These readily accessible indices may serve as valuable tools for individualized clinical decision-making.