全身免疫炎症指数对HER2阴性晚期胃癌患者一线化疗疗效及生存结局的预测价值

周阳阳; 刘静; 朱叶青; 杨燕; 周争光; 王明喜

doi:10.16766/j.cnki.issn.1674-4152.003283

全身免疫炎症指数对HER2阴性晚期胃癌患者一线化疗疗效及生存结局的预测价值

doi: 10.16766/j.cnki.issn.1674-4152.003283

1.
蚌埠医学院第一附属医院肿瘤内科，安徽蚌埠 233004
2.
蚌埠医学院临床医学院，安徽蚌埠 233030

基金项目:

安徽省卫健委卫生健康科研重点项目 AHWJ2022a010

安徽省大学生创新训练计划项目 S202110367134

蚌埠医学院自然科学基金重点项目 2021byzd110

详细信息

通讯作者:
王明喜，E-mail：drwmx@126.com

中图分类号: R735.2 R730.53
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出版历程
- 收稿日期: 2023-04-12
- 网络出版日期: 2024-01-29

Value of systemic immune inflammation index in predicting the efficacy of first-line chemotherapy and survival outcome in patients with HER2 negative advanced gastric cancer

1.
Department of Medical Oncology, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的探讨全身免疫炎症指数(SII)与晚期胃癌患者一线化疗疗效及预后的相关性。方法回顾性收集2017年2月—2021年6月于蚌埠医学院第一附属医院肿瘤内科接受一线化疗的90例HER2阴性晚期胃癌患者的病理资料，根据基线血常规化验结果计算SII值。分别采用受试者工作特征曲线和X-tile软件选取SII治疗疗效和预后的最佳临界值，根据临界值将晚期胃癌患者分为高、低SII组，分析HER2阴性晚期胃癌患者基线SII与其临床病理特征、一线化疗疗效、无进展生存期(PFS)和总生存期(OS)的关系。结果共纳入90例HER2阴性晚期胃癌患者，高、低SII组患者的客观缓解率分别为3.45%(1/29)和19.67%(12/61)，疾病控制率分别为41.38%(12/29)和77.05%(47/61)。基线SII越低，患者化疗疗效越好(χ²=11.075，P=0.001)。低SII组患者的PFS显著长于高SII组(4.57个月 vs. 2.13个月，P<0.001)，低SII组患者的OS亦显著长于高SII组(9.83个月 vs. 3.97个月，P<0.001)。单因素和多因素Cox分析结果显示，基线SII水平是HER2阴性晚期胃癌患者一线治疗PFS和OS的独立影响因素。结论基线SII水平有预测HER2阴性晚期胃癌患者一线化疗疗效和生存结局的潜在价值，高SII与疗效差和不良预后有关。
- 晚期胃癌 /
- 全身免疫炎症指数 /
- 疗效 /
- 预后
Abstract: Objective To explore the value of the systemic immune-inflammatory index (SII) in predicting the efficacy of first-line chemotherapy and survival in patients with human epidermal growth factor receptor 2 (HER2) negative advanced gastric cancer. Methods The clinical data of advanced gastric cancer patients who received standard first-line chemotherapy at the Department of Medical Oncology, the First Affiliated Hospital of Bengbu Medical College from February 2017 to June 2021 were retrospectively collected. The SII values were calculated based on the results of the baseline routine blood test. The receiver operating characteristic (ROC) curve and X-tile software were used to determine the optimal cut off value of SII for therapeutic effect and prognosis, and patients was classified into high and low SII groups. The relationship between SII and clinicopathological characteristics, efficacy of first-line chemotherapy, progression-free survival (PFS) and overall survival (OS) of patients with advanced gastric cancer was analyzed. Results A total of 90 patients with advanced gastric cancer were enrolled. The objective response rates of patients in the high and low SII groups were 3.45% (1/29) and 19.67% (12/61), and the disease control rates were 41.38% (12/29) and 77.05% (47/61), respectively; patients with lower baseline SII had better chemotherapy efficacy (χ²=11.075, P=0.001). The mPFS of patients in the low SII group was significantly longer than that of patients in the high SII group (4.57 months vs. 2.13 months, P<0.001), and patients with low SII achieved a longer OS than patients with high SII (9.83 months vs. 3.97 months, P<0.001). The results of univariate and multivariate Cox analysis showed that the level of baseline SII was an independent prognostic factor affecting PFS and OS of first-line therapy in patients with advanced gastric cancer. Conclusion The baseline level of SII has potential value in predicting the efficacy and prognosis of first-line chemotherapy in patients with advanced gastric cancer, and patients with high SII tend to have poor efficacy and prognosis.
- Advanced gastric cancer /
- Systemic immune inflammation index /
- Efficacy /
- Prognosis

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图 1 晚期胃癌患者PFS的Kaplan-Meier生存曲线

注：A为总人群PFS的生存曲线；B为高、低基线SII组患者PFS的生存曲线。

Figure 1. Kaplan-Meier survival curve for PFS in patients with advanced gastric cancer

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图 2 晚期胃癌患者OS的Kaplan-Meier生存曲线

注：A为总人群OS的生存曲线；B为高、低基线SII组患者OS的生存曲线。

Figure 2. Kaplan-Meier survival curve for OS in patients with advanced gastric cancer

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表 1 不同临床病理特征晚期胃癌患者基线SII比较[M(P₂₅, P₇₅), ×10⁹/L]

Table 1. Baseline data of patients with diverse clinicopathological features in advanced gastric cancer[M(P₂₅, P₇₅), ×10⁹/L]

项目	例数	SII	统计量	P值
性别			-0.430^a	0.667
男性	58	549.04(419.54, 831.20)
女性	32	645.08(436.49, 913.42)
年龄(岁)			-1.153^a	0.249
<65	54	617.03(451.25, 886.95)
≥65	36	536.19(402.23, 815.14)
ECOG评分(分)			-1.023^a	0.306
0~1	68	563.47(422.07, 771.21)
2	22	661.66(468.89, 978.90)
病理类型			0.650^b	0.723
腺癌	72	553.26(422.07, 830.87)
印戒细胞癌	13	611.82(438.96, 829.13)
其他	5	658.96(404.97, 1 407.29)
原发肿瘤部位			2.116^b	0.347
贲门	28	508.26(411.69, 750.62)
胃体	45	622.24(431.14, 908.21)
远端	17	574.71(475.85, 956.30)
转移数目(个)			-1.003^a	0.316
<2	42	549.04(416.64, 754.38)
≥2	48	592.39(442.30, 952.87)
肝转移			-0.741^a	0.459
无	62	605.72(467.51, 827.55)
有	28	560.39(400.26, 855.65)
肺转移			-0.679^a	0.497
无	76	579.93(422.07, 817.49)
有	14	624.73(452.46, 1 168.80)
浆膜腔积液			-0.475^a	0.635
无	74	572.66(419.54, 879.03)
有	16	610.93(472.62, 703.91)
CEA(ng/mL)			-0.315^a	0.752
<5.00	42	563.47(426.98, 854.59)
≥5.00	48	620.23(427.72, 843.27)
CA199(IU/mL)			-1.400^a	0.161
<37.00	51	547.89(417.27, 825.96)
≥37.00	39	679.56(480.82, 940.46)
Hb(g/L)			-0.195^a	0.845
<110.00	40	608.18(400.26, 932.39)
≥110.00	50	552.11(447.28, 775.46)
疗效			-3.324^a	0.001
CR+PR+SD	59	539.65(409.42, 716.79)
PD	31	773.05(530.80, 1 136.94)
注：^a为Z值，^b为H值。

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表 2 高、低SII组晚期胃癌患者一线化疗疗效比较(例)

Table 2. Comparison of first-line chemotherapy effect in patients with advanced gastric cancer categorized into high and low SII groups (cases)

组别	例数	CR+PR+SD	PD
低SII组	61	47	14
高SII组	29	12	17
χ²值		11.075
P值		0.001

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表 3 变量赋值方法

Table 3. Variable assignment method

变量	赋值方法
性别	女性=0，男性=1
年龄	< 65岁=0，≥65岁=1
ECOG评分	0~1分=0，2分=1
病理类型	腺癌=(0，0，0)，印戒细胞癌=(0，1，0)，其他=(0，0，1)
原发肿瘤部位	贲门=(0，0，0)，胃体=(0，1，0)，远端=(0，0，1)
转移器官数目	< 2个=0，≥2个=1
肝转移	无=0，有=1
肺转移	无=0，有=1
浆膜腔积液	无=0，有=1
CEA	< 5.00 ng/mL=0，≥5.00 ng/mL=1
CA199	< 37.00 IU/mL=0，≥37.00 IU/mL=1
Hb	< 110.00 g/L=0，≥110.00 g/L=1
SII	< 750.60×10⁹/L=0，≥750.60×10⁹/L=1

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表 4 晚期胃癌患者PFS影响因素的单因素Cox回归分析

Table 4. Univariate Cox regression analysis of factors influencing PFS in patients with advanced gastric cancer

变量	SE	Wald χ²	HR值	95% CI	P值
男性	0.224	1.502	0.760	0.489~1.179	0.220
年龄≥65岁	0.220	0.058	0.948	0.616~1.461	0.810
ECOG评分2分	0.255	2.423	0.672	0.408~1.108	0.120
病理类型
印戒细胞癌 vs. 腺癌	0.316	0.219	1.159	0.624~2.152	0.640
其他 vs. 腺癌	0.527	1.018	0.588	0.209~1.650	0.313
位置
胃体 vs. 贲门	0.248	0.003	1.013	0.623~1.647	0.958
远端 vs. 贲门	0.316	3.778	1.848	0.995~3.432	0.052
转移器官数目≥2个	0.216	0.130	1.081	0.708~1.652	0.718
肝转移	0.234	1.785	0.731	0.462~1.157	0.182
肺转移	0.296	3.241	1.705	0.954~3.049	0.072
有浆膜腔积液	0.281	0.446	1.206	0.696~2.092	0.504
CEA≥5.00 ng/mL	0.215	0.010	1.022	0.670~1.558	0.919
CA199≥37.00 IU/mL	0.215	1.791	1.334	0.875~2.035	0.181
Hb≥110.00 g/L	0.217	0.793	1.213	0.793~1.856	0.373
SII≥750.60×10⁹/L	0.259	25.254	3.678	2.213~6.113	< 0.001

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表 5 晚期胃癌患者PFS影响因素的多因素Cox回归分析

Table 5. Multivariate Cox regression analysis of factors influencing PFS in patients with advanced gastric cancer

变量	SE	Wald χ²	HR值	95% CI	P值
位置	0.337	6.357	2.339	1.208~4.530	0.012
转移器官数目	0.247	0.552	0.832	0.513~1.350	0.457
肺转移	0.340	0.442	1.253	0.644~2.440	0.506
浆膜腔积液	0.297	1.974	1.518	0.848~2.719	0.160
SII	0.273	27.802	4.216	2.469~7.196	< 0.001

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表 6 晚期胃癌患者OS影响因素的单因素Cox回归分析

Table 6. Univariate Cox regression analysis of factors influencing OS in patients with advanced gastric cancer

变量	SE	Wald χ²	HR值	95% CI	P值
男性	0.235	3.805	0.632	0.399~1.002	0.051
年龄≥65岁	0.240	0.848	0.802	0.501~1.283	0.357
ECOG评分2分	0.279	0.815	1.287	0.744~2.224	0.367
病理类型
印戒细胞癌 vs. 腺癌	0.331	2.052	1.607	0.840~3.076	0.152
其他 vs. 腺癌	0.518	0.076	1.154	0.418~3.184	0.783
位置
胃体 vs. 贲门	0.268	1.417	1.376	0.813~2.328	0.234
远端 vs. 贲门	0.343	3.284	1.863	0.950~3.651	0.070
转移器官数目≥2个	0.233	0.993	1.261	0.799~1.991	0.319
肝转移	0.244	0.086	1.074	0.666~1.733	0.770
肺转移	0.319	1.017	1.379	0.738~2.575	0.313
有浆膜腔积液	0.290	1.167	1.368	0.775~2.415	0.280
CEA≥5.00 ng/mL	0.232	3.006	0.669	0.424~1.054	0.083
CA199≥37.00 IU/mL	0.235	0.137	0.917	0.578~1.453	0.712
Hb≥110.00 g/L	0.235	0.016	0.971	0.613~1.538	0.900
SII≥750.60×10⁹/L	0.267	30.899	4.401	2.610~7.421	＜0.001

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表 7 晚期胃癌患者OS影响因素的多因素Cox回归分析

Table 7. Multivariate Cox regression analysis of factors influencing OS in patients with advanced gastric cancer

变量	SE	Wald χ²	HR值	95% CI	P值
性别	0.252	0.198	0.894	0.545~1.465	0.656
位置	0.365	4.299	2.133	1.042~4.363	0.038
转移器官数目≥2个	0.252	0.472	1.189	0.725~1.950	0.492
CEA≥5.00 ng/mL	0.254	2.295	0.681	0.414~1.119	0.130
SII≥750.60×10⁹/L	0.289	33.333	5.305	3.011~9.348	＜0.001

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