摘要
目的:探讨体质量指数(BMI)、预后营养指数(PNI)与晚期非小细胞肺癌(NSCLC)合并非酒精性脂肪肝(NAFLD)患者临床特征的关系及对免疫治疗预后的价值。方法:回顾性收集免疫检查点抑制剂(ICI)治疗晚期NSCLC合并NAFLD患者47例,收集治疗前临床参数,计算BMI及PNI值,分析PNI最佳界值及BMI、PNI与临床特征的关系,比较肥胖组和不同PNI组免疫治疗反应及效果。结果:晚期NSCLC合并NAFLD患者PNI最佳界值为44.15。ICI治疗总ORR为31.9%,DCR为61.7%;BMI<25 kg/m^(2)和BMI≥25 kg/m^(2)亚组ORR、DCR差异无统计学意义;低PNI和高PNI组ORR、DCR分别为13.3%、50.0%和64.7%、82.4%,差异有统计学意义;PD-L1表达、BMI值、PNI值是影响PFS的显著因素,肝转移、肿瘤分化、PD-L1表达、BMI是影响OS的显著因素。结论:免疫检查点抑制剂治疗晚期NSCLC合并NAFLD患者,基线BMI、PNI与生存改善相关。因此,基线BMI、PNI可能是未来免疫检查点抑制剂治疗的预后因素。
Objective:To investigate the relationship between body mass index(BMI),prognostic nutritional index(PNI)and clinical features and the prognostic value of patients with advanced non-small cell lung cancer(NSCLC)and non-alcoholic fatty liver disease(NAFLD)treated with immune checkpoint inhibitor(ICI).Methods:47 patients with advanced NSCLC and NAFLD treated with ICI were retrospectively analyzed.The clinical pathological parameters before treatment were analyzed,BMI and PNI were calculated.The optimal PNI cutoff value and the relationship between BMI,PNI and clinical features were analyzed.The immune response and therapeutic effect of immunotherapy were compared between obesity group and different PNI groups.Results:The optimal cutoff value of PNI in patients with advanced NSCLC and NAFLD was 44.15.The overall ORR and DCR of ICI treatment were 31.9%and 61.7%,respectively.There was no significant difference in ORR and DCR between BMI<25 kg/m^(2) and BMI≥25 kg/m^(2) subgroups(P>0.05).ORR and DCR of low PNI group and high PNI group were 13.3%,50.0%and 64.7%,82.4%,respectively,with statistical significance(P<0.05).PD-L1 expression,BMI value and PNI value were significant factors influencing PFS,and liver metastasis,tumor differentiation,PD-L1 expression and BMI were significant factors affecting OS.Conclusion:Baseline BMI and PNI are associated with survival improvement in patients with advanced NSCLC and NAFLD treated with immune checkpoint inhibitor.Therefore,baseline BMI and PNI may be the prognostic factors of immunosuppressive therapy in the future.
作者
刘小小
陈秀红
张中冕
LIU Xiaoxiao;CHEN Xiuhong;ZHANG Zhongmian(The Second Affiliated Hospital of Zhengzhou University,Henan Zhengzhou 450000,China)
出处
《现代肿瘤医学》
CAS
北大核心
2021年第22期3954-3958,共5页
Journal of Modern Oncology
基金
北京医卫健康公益基金会项目(编号:B182134)。
关键词
非小细胞肺癌
非酒精性脂肪肝
肥胖
预后营养指数
免疫治疗
non-small cell lung cancer
non-alcoholic fatty liver disease
obesity
prognostic nutritional index
immunotherapy
