SII、PNI与晚期胃癌患者免疫检查点抑制剂治疗疗效及预后的关系

Association of SII and PNI with Efficacy and Prognosis of Immune Checkpoint Inhibitors in Patients with Advanced Gastric Cancer

摘要: 目的：研究SII、PNI与晚期胃癌患者免疫检查点抑制剂(Immune checkpoint inhibitors, ICIs)治疗疗效及预后的关系。方法：选取2018年1月~2021年5月在青岛大学附属青岛市市立医院接受ICIs (主要为PD-1/PD-L1抑制剂)治疗的晚期胃癌患者65例。以各组中位数为SII、PNI截断值，根据是否大于截断值将患者分为低SII、PNI组及高SII、PNI组。比较两组患者免疫治疗后的疾病控制率(DCR)及无进展生存时间(PFS)。结果：65例入组患者的中位年龄为64岁，其中男性45例，女性20例。SII、PNI的截断值分别为563.3、43.2 ng/mL，其中低SII组32例，高SII组33例，低PNI组32例，高PNI组33例。高、低值组SII的DCR分别为51.5%、71.9%，治疗前SII水平与DCR之间不具有相关性(P > 0.05)。高、低值组PNI的DCR分别为75.8%、46.9%，PNI水平与DCR之间具有相关性(P < 0.05)。低SII、高PNI预示ICIs治疗的晚期胃癌患者较长的PFS (SII的HR = 0.407，95% CI：0.179~0.925，P = 0.032；PNI的HR = 3.438，95% CI：1.466~8.062，P = 0.005)。多因素分析结果显示，SII、PNI是PFS的独立风险因素(P < 0.05)。结论：SII、PNI可以预测晚期胃癌患者免疫治疗的疗效及预后，未来有望成为新的预测指标。

Abstract: Objective: To investigate whether SII, PNI are associated with Immune checkpoint inhibitors (ICIs) efficacy in patients with advanced gastric cancer. Methods: 65 patients with advanced gastric cancer who were treated with Immune checkpoint inhibitors (ICIs) at Qingdao Municipal Hospital affiliated to Qingdao University from January 2018 to May 2021 were enrolled in this retrospective study. The optimal cut-off values of SII, PNI for predicting efficacy and prognosis were determined accord-ing to the median of each group. Disease Control Rate (DCR) and Progression Free Survival (PFS) were calculated and compared using Kaplan-Meier method and log-rank test. Results: The median age of the 65 patients was 64 years old, including 45 males and 20 females. The optimal cut-off val-ues of SII/PNI were 563.3 and 43.2 ng/mL, respectively. 32 patients were in the low SII group, and 33 patients were in the high SII group, 32 patients were in the low PNI group, and 33 patients were in the high PNI group. The DCR of SII in high and low value groups was 51.5% and 71.9% respec-tively, and there was no correlation between SII level and DCR (P > 0.05). The DCR of PNI in high and low value groups was 75.8% and 46.9%, and there was a correlation between PNI level and DCR (P < 0.05). Low SII and high PNI were associated with longer PFS (HR for SII = 0.407, 95% CI: 0.179~0.925, P= 0.032; HR for PNI = 3.438, 95% CI: 1.466~8.062, P = 0.005). The results of multi-variate analysis showed that SII and PNI were independent risk factors for PFS (P < 0.05). Conclu-sion: SII and PNI can predict the efficacy and prognosis of immunotherapy in patients with ad-vanced gastric cancer, and are expected to be new predictors in the future.