炎症标志物、前白蛋白和白蛋白在晚期实体肿瘤患者抗PD-1治疗中临床疗效的预测价值

The Predictive Value of Inflammatory Markers, Prealbumin, and Albumin in the Clinical Efficacy of PD-1 Therapy in Advanced Solid Tumor Patients

摘要: 目的：本研究旨在评估探究炎症标志物、前白蛋白和白蛋白对晚期实体肿瘤患者抗PD-1治疗中临床疗效的预测价值。方法：回顾性分析2019年1月至2023年10月在青岛市市立医院接受PD-1抑制剂治疗的374例晚期实体肿瘤患者，并收集上述患者的基线临床特征和血液参数。通过X-tile软件3.6.1版本分析炎症标志物，计算最佳截断值并将其分为高和低水平组，绘制两组间Kaplan-Meier生存曲线，进行Log-Rank检验。单因素和多因素COX回归分析估算无进展生存期(PFS)的风险比及95%可信区间，绘制森林图进行展示。在整个分析过程中，P < 0.05被认为具有统计学意义。结果：C反应蛋白(CRP)基线水平升高和前白蛋白(PAB)基线水平降低与患者的PFS显著缩短相关(P < 0.01)。多因素分析结果表明，白蛋白(ALB)、CRP和PAB是影响患者PFS的独立预后因素(P < 0.05)。结论：在晚期实体肿瘤患者接受PD-1抑制剂治疗过程中，炎症标志物水平的下降以及PAB和ALB水平的升高表明患者病情缓解，相反则提示病情进展。本研究中，虽然动态监测炎症标志物水平变化与irAEs的发生未见明显相关，但它们对于预测PD-1抑制剂抗肿瘤治疗的临床疗效以及提高治疗应答率具有潜在价值。

Abstract: Objective: This study aims to assess the predictive value of inflammatory markers, prealbumin, and albumin for the clinical efficacy of PD-1 therapy in advanced solid tumor patients. Methods: A retrospective analysis was conducted on 374 advanced solid tumor patients who received PD-1 inhibitor treatment at Qingdao Municipal Hospital from January 2019 to October 2023. Baseline clinical characteristics and blood parameters of these patients were collected. Using X-tile software version 3.6.1, inflammatory markers were analyzed, optimal cutoff values were calculated, and patients were categorized into high and low-level groups. Kaplan-Meier survival curves were plotted for the two groups, and the Log-Rank test was performed. Univariate and multivariate COX regression analyses were conducted to estimate the hazard ratio and 95% confidence interval for progression-free survival (PFS), and forest plots were generated for display. The correlation between clinical baseline data, relevant indicators, and immune-related adverse events (irAEs) in patients was analyzed. Throughout the analysis, P < 0.05 was considered statistically significant. Results: Elevated baseline levels of C-reactive protein (CRP) and decreased baseline levels of prealbumin (PAB) were significantly associated with shortened PFS in patients (P < 0.01). Multivariate analysis results indicated that albumin (ALB), CRP, and PAB were independent prognostic factors affecting patient PFS (P < 0.05). Conclusion: In patients with advanced solid tumors receiving PD-1 inhibitor treatment, a decrease in inflammatory marker levels and an increase in PAB and ALB levels suggest disease improvement, while the opposite indicates disease progression. Although dynamic monitoring of changes in inflammatory marker levels did not show a clear correlation with the occurrence of irAEs in this study, they have potential value in predicting the clinical efficacy of PD-1 inhibitor anti-tumor treatment and improving treatment response rates.