SII与PNI对PD-L1阳性胃癌术后复发的预测价值
The Predictive Value of SII and PNI for Postoperative Recurrence in PD-L1-Positive Gastric Cancer
摘要: 胃癌仍是预后较差的消化道恶性肿瘤，尽管免疫检查点抑制剂(ICI)的应用为部分患者带来生存获益，但根治术后复发转移风险居高不下，单一PD-L1阳性状态难以满足精准分层需求。近年来，外周血来源的系统性免疫炎症指数(SII)与预后营养指数(PNI)因简便易得而受到关注，分别从炎症负荷与营养–免疫储备维度反映宿主抗肿瘤能力。本综述系统梳理SII与PNI的生物学基础、其在胃癌根治术后复发转移中的预测证据，并聚焦于PD-L1阳性亚组中的适用性，进一步探讨炎症–营养轴通过塑造免疫抑制微环境影响微小残留病灶持续存在的潜在机制。现有证据表明，SII升高与PNI降低均为胃癌术后不良预后的独立危险因素，且在接受ICI治疗的患者中亦具显著判别效能。二者可作为补充PD-L1单一标志物不足的有效工具，为术后个体化辅助治疗与随访策略优化提供新思路。然而，截断值不统一、回顾性研究居多及缺乏直接针对PD-L1阳性术后人群的前瞻性验证仍是当前主要局限，未来需进一步开展多中心研究以推动临床转化。
Abstract: Gastric cancer remains a digestive tract malignancy with a poor prognosis. Although the application of immune checkpoint inhibitors (ICIs) has brought survival benefits to some patients, the risk of recurrence and metastasis after radical resection remains persistently high, and PD-L1 positivity alone is insufficient to meet the needs of precise risk stratification. SII and PNI are easy to get from routine blood tests. SII tells us about inflammation, and PNI reflects nutrition and immune status. Both are thought to reflect the patient’s ability to fight cancer. In this review, we look at their biological background and their role in predicting recurrence after gastric cancer surgery. We pay special attention to PD-L1-positive patients. We also explore how inflammation and nutrition work together to create an immunosuppressive environment, which may help keep residual tumor cells alive. According to current data, high SII and low PNI are both linked to worse outcomes after surgery. They also work well in patients on immunotherapy. So these markers might be useful add-ons to PD-L1 testing, giving us more information for treatment and follow-up decisions. But there are still problems. Cutoff values vary across studies. Most evidence comes from retrospective data. And we lack prospective studies focusing on PD-L1-positive patients after surgery. More multicenter research is needed before we can use them in routine practice.
文章引用：邹凯迪, 李小宝, 毋宇哲, 崔登铜, 张灏瑜, 袁江涛. SII与PNI对PD-L1阳性胃癌术后复发的预测价值[J]. 临床个性化医学, 2026, 5(4): 478-485. https://doi.org/10.12677/jcpm.2026.54273

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