外周血指标在晚期非小细胞肺癌疗效评估中的价值

The Value of Peripheral Blood Index in the Evaluation of Curative Effect of Advanced Non-Small Cell Lung Cancer

摘要: 目的：探讨预后营养指数、CEA在晚期非小细胞肺癌免疫治疗疗效评估中的价值。方法：回顾性收集2018年1月至2022年1月符合本研究纳入、排除标准的晚期NSCLC患者临床资料，绘制受试者工作特征曲线(Receiver operating characteristic curve, ROC曲线)，以ROC曲线法确定最佳截断值，将PNI、CEA按截断值各分为高低两组，通过卡方检验比较各组患者ORR、DCR的差异。采用Kaplan-Meier法进行单因素生存分析，采用log-rank检验分析和比较各组间生存差异。将单因素分析中有统计学意义的因素纳入Cox比例回归模型进行多因素分析。结果：H-PNI组患者的ORR (28.2%)高于L-PNI组患者的ORR (0)，差异具有统计学意义(P = 0.014)，H-PNI组患者的DCR (48.7%)高于L-PNI组患者的DCR (13.0%)，差异具有统计学意义(P = 0.005)，H-CEA组患者的DCR (12.5%)明显低于L-CEA组患者的DCR (50.0%)，差异具有统计学意义(P = 0.003)。多因素生存分析提示：PNI、CEA是PFS的独立预后因素。结论：接受免疫单药治疗的晚期非小细胞肺癌患者，治疗前低CEA、高PNI与较好的ORR、DCR相关，并且是PFS的独立预后因素，可以帮助临床医生筛选出免疫治疗优势人群。

Abstract: Objective: To explore the value of prognostic nutritional index and CEA in evaluating the efficacy of immunotherapy for advanced non-small cell lung cancer. Methods: To explore the value of prognos-tic nutritional index and CEA in evaluating the efficacy of immunotherapy for advanced non- small cell lung cancer. The clinical data of patients with advanced NSCLC who met the inclusion and exclu-sion criteria of this study from January 2018 to January 2022 were retrospectively collected, and the receiver operating characteristic curve (ROC curve) was drawn. The best cutoff value was de-termined by ROC curve method. PNI and CEA were divided into two groups according to the cutoff value. The differences of ORR and DCR of patients in each group were compared by chi-square test. The Kaplan-Meier method was used for single-factor survival analysis, and the log- rank test was used to analyze and compare the survival differences between the groups. The statistically signifi-cant factors in the single factor analysis were included in the Cox proportional regression model for multi-factor analysis. Results: The ORR of patients in H-PNI group (28.2%) was higher than that in L-PNI group (0), with a statistically significant difference (P = 0.014). The DCR of patients in H-PNI group (48.7%) was higher than that in L-PNI group (13.0%), with a statistically significant differ-ence (P = 0.005). The DCR of patients in H-CEA group (12.5%) was significantly lower than that in L-CEA group (50.0%), with a statistically significant difference (P = 0.003). Multivariate survival analysis showed that PNI and CEA were independent prognostic factors of PFS. Conclusion: For pa-tients with advanced non-small cell lung cancer who received immunomonotherapy, low CEA and high PNI before treatment are associated with better ORR and DCR, and are independent prognostic factors of PFS, which can help clinicians screen out immunotherapy advantages.