The correlation between body mass index, systemic immune-inflammation index with the efficacy and prognosis of immunotherapy in NSCLC patients
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摘要:
目的 探讨体重指数(BMI)及全身免疫炎症指数(SII)与非小细胞肺癌(NSCLC)患者免疫治疗效果、预后的相关性，为个体化临床治疗提供理论基础。 方法 回顾性纳入马鞍山十七冶医院及马鞍山市人民医院2021年8月—2022年8月收治的140例NSCLC患者，以基线BMI值将患者分为低BMI组(BMI＜25，108例)及高BMI组(BMI≥25，32例)，并以基线SII中位数为界，将患者分为低SII组(SII＜642.40，70例)和高SII组(SII≥642.40，70例)。分析BMI及SII与患者免疫治疗效果的相关性，并对患者进行为期2年的随访，统计患者生存预后，以Cox回归分析探讨NSCLC患者生存预后的影响因素。 结果 低BMI组免疫治疗周期结束时客观缓解率(ORR)为45.37%(49/108)，低于高BMI组的75.00%(24/32，χ2=8.685，P=0.003)；高SII组免疫治疗周期结束时ORR为37.14%(26/70)，低于低SII组的67.14%(47/70，χ2=12.623，P＜0.001)。随访2年，中位随访时间为(12.07±3.45)个月。BMI＜25、合并肾上腺转移、肝转移、SII≥642.40的患者中位无进展生存期(PFS)分别低于BMI≥25、无肾上腺转移、肝转移、SII＜642.40的患者(P＜0.05)。Cox回归分析显示，BMI＜25、合并肾上腺转移、肝转移及SII≥642.40均为影响NSCLC患者中位PFS的危险因素(P＜0.05)。 结论 BMI及SII均与NSCLC患者免疫治疗效果密切相关，且均为患者出现不良预后的影响因素。 Abstract:Objective To investigate the correlation of body mass index (BMI) and systemic immunoinflammatory index (SII) with immunotherapy efficacy and prognosis in patients with non-small cell lung cancer (NSCLC), providing the theoretical basis for individualized clinical treatment. Methods A total of 140 patients with NSCLC admitted to Ma ' anshan Shiqiye Hospital and Ma ' anshan People ' s Hospital from August 2021 to August 2022 were retrospectively included. Patients were separated into low BMI group (BMI＜25, n=108) and high BMI group (BMI≥25, n=32) based on baseline BMI value, and were separated into low SII group (SII＜642.40, n=70) and high SII group (SII≥642.40, n=70) based on baseline median SII value as the boundary. The correlation of BMI and SII with immunotherapy efficacy of patients was analyzed, and the patients were followed up for two years to analyze the survival prognosis of patients. Cox regression analysis was used to explore the factors affecting the survival prognosis of patients with NSCLC. Results The objective remission rate (ORR) at the end of immunotherapy cycle in low BMI group was lower [45.37% (49/108) vs. 75.00% (24/32), χ2=8.685, P=0.003], and ORR was lower in the high SII group than the low SII group [37.14% (26/70) vs. 67.14% (47/70), χ2=12.623, P < 0.001]. After two years of follow-up, the median follow-up time was (12.07±3.45) months. The median progression-free survival (PFS) in patients with BMI < 25, adrenal metastasis, liver metastasis, and SII≥642.40 was lower than that in patients with BMI < 25, no adrenal metastasis and liver metastasis, and SII < 642.40, respectively (P < 0.05). Cox regression analysis showed that BMI < 25, adrenal metastasis, liver metastasis and SII≥642.40 were all risk factors for the median PFS in NSCLC patients (P < 0.05). Conclusion Both BMI and SII are closely related to immunotherapy efficacy in patients with NSCLC and are risk factors for poor prognosis. -
图 1 不同BMI值NSCLC患者PFS生存曲线
Figure 1. PFS survival curves of NSCLC patients with different BMI values
图 2 不同SII值NSCLC患者PFS生存曲线
Figure 2. PFS survival curves of NSCLC patients with different SII values
表 1 不同BMI值NSCLC患者临床疗效比较[例(%)]
Table 1. Comparison of clinical efficacy of NSCLC patients with different BMI values [cases (%)]
组别 例数 CR PR SD PD ORR 低BMI组 108 1(0.93) 48(44.44) 57(52.78) 2(1.85) 49(45.37) 高BMI组 32 0 24(75.00) 7(21.88) 1(3.12) 24(75.00) 统计量 2.710a 8.685b P值 0.007 0.003 注：a为Z值，b为χ2值。 
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表 2 不同SII值NSCLC患者临床疗效比较[例(%)]
Table 2. Comparison of clinical efficacy of NSCLC patients with different SII values [cases (%)]
组别 例数 CR PR SD PD ORR 低SII组 70 1(1.43) 46(65.71) 22(31.43) 1(1.43) 47(67.14) 高SII组 70 0 26(37.14) 42(60.00) 2(2.86) 26(37.14) 统计量 3.560a 12.623b P值 ＜0.001 ＜0.001 注：a为Z值，b为χ2值。
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表 3 NSCLC患者中位PFS影响因素的单因素分析
Table 3. Univariate analysis of median PFS in NSCLC patients
项目 例数 中位PFS(月) log-rank χ2 P值 性别 1.014 0.336 男性 104 7.9 女性 36 8.5 年龄 0.882 0.631 ≤60岁 33 7.1 ＞60岁 107 7.0 BMI 7.454 0.006 ＜25 108 6.3 ≥25 32 8.1 肿瘤部位 1.288 0.245 左肺 57 7.9 右肺 81 8.1 双肺 2 7.5 TNM分期 1.147 0.375 Ⅲ期 27 8.7 ⅣA期 68 7.4 ⅣB期 45 7.2 病理类型 1.002 0.401 鳞癌 64 8.5 腺癌 76 8.1 EGFR突变 1.225 0.273 有 19 7.3 无 121 7.7 脑转移 1.436 0.157 有 42 7.1 无 98 7.8 骨转移 2.014 0.067 有 55 7.0 无 85 8.1 肾上腺转移 5.143 0.022 有 72 5.7 无 68 7.4 肝转移 10.103 ＜0.001 有 65 5.5 无 75 9.0 治疗方案 4.511 0.094 单用免疫治疗 22 6.7 免疫+化疗 82 7.5 免疫+靶向 17 7.9 免疫+化疗+靶向 19 8.3 SII 6.038 0.014 ＜642.40 70 9.0 ≥642.40 70 6.8
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表 4 NSCLC患者中位PFS影响因素的Cox回归分析
Table 4. Cox regression analysis of factors influencing median PFS in NSCLC patients
变量 B SE Waldχ2 P值 HR(95% CI) BMI 0.592 0.118 9.695 ＜0.001 2.049(1.113~3.044) 肾上腺转移 0.433 0.219 6.224 0.012 1.367(1.084~2.225) 肝转移 0.525 0.174 7.442 0.006 1.945(1.105~2.893) SII 0.605 0.085 11.720 ＜0.001 2.185(1.121~3.349)
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