SII/ALB对接受阿片类药物和免疫治疗的NSCLC患者预后的预测价值<sup>★</sup>

doi:10.3969/j.issn.2095-1264.2025.02.13

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SII/ALB对接受阿片类药物和免疫治疗的NSCLC患者预后的预测价值★
DOI:
                        10.3969/j.issn.2095-1264.2025.02.13
                    
作者:
                        
                        
                    
作者单位:徐州市中心医院/徐州医科大学徐州临床学院 肿瘤内科，江苏 徐州，221009
作者简介:雷雁，女，硕士，住院医师，研究方向为肺癌及晚期肿瘤的综合治疗。
通讯作者:刘勇，男，博士，主任医师，研究方向为肺癌及晚期肿瘤的综合治疗及终末期患者的症状管理。
中图分类号:R734.2
基金项目:★徐州医科大学创新团队项目（XYFC2021006）；徐州市卫生健康委员会重点项目（XWKYHT20210589）。

Prognostic value of systemic immune inflammation index/albumin ratio for NSCLC patients receiving opioids and immunotherapy^★

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Department of Medical Oncology, Xuzhou Central Hospital / Xuzhou Clinical College of Xuzhou Medical University,Xuzhou, 221009, Jiangsu, China

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摘要:

目的评估全身免疫炎症指数（SII）/血清白蛋白（ALB）比值对接受阿片类药物和免疫检查点抑制剂（ICI）治疗的非小细胞肺癌（NSCLC）伴癌痛患者预后的预测价值。方法回顾性分析2021年9月1日至2023年9月1日在徐州市中心医院接受阿片类药物和ICIs治疗的78例NSCLC伴癌痛患者的资料，收集ICIs治疗前30天内的影像学及血液学数据。通过受试者操作特征（ROC）曲线确定SII/ALB的临界值，采用卡方检验分析SII/ALB与临床数据之间的关系。采用Kaplan-Meier曲线分析患者的无进展生存期（PFS），单因素及多因素Cox回归分析探讨影响肺癌患者预后的危险因素。结果治疗前SII/ALB的ROC曲线下面积为0.834，对应临界值为17.79，据此将患者分为低SII/ALB组（≤17.79）和高SII/ALB组（>17.79）。治疗前SII/ALB比值与肺癌类型、ECOG PS评分、分期、免疫治疗线数、治疗方案、不良反应及中性粒细胞水平显著相关（P<0.05）。低SII/ALB组患者中位PFS明显长于高 SII/ALB组（NR vs. 5.7个月，P<0.001）。低SII/ALB组客观缓解率（ORR）和疾病控制率（DCR）显著高于高SII/ALB组（ORR： 35.14% vs. 9.76%，P=0.007； DCR： 72.97% vs. 39.02%， P=0.003）。NRS评分（HR=0.327， 95% CI： 0.146~0.736， P=0.007）、分期（HR=0.061， 95% CI： 0.021~0.183， P<0.001）和SII/ALB（HR=0.026， 95% CI： 0.009~0.075， P<0.001）是PFS的独立风险因素。结论 SII/ALB可能是预测接受阿片类药物和ICIs治疗的NSCLC患者预后的重要生物学指标。

Abstract:

Objective To evaluate the prognostic value of the systemic immune-inflammation index/albumin (SII/ALB) ratio for non-small cell lung carcinoma (NSCLC) patients with cancer pain undergoing treatment with opioids and immune checkpoint inhibitors (ICIs).Methods A retrospective analysis was conducted on 78 NSCLC cancer patients with cancer pain treated with ICIs at Xuzhou Central Hospital from September 1, 2021 to September 1, 2023. Patient imaging and blood data at 30 d prior to ICI therapy were collected. The cut-off value of SII/ALB was determined using the ROC curve, and the relationship between SII/ALB and clinical data was analyzed using the chi-square test. Kaplan-Meier curves were used to analyze the progression-free survival (PFS) of patients, and univariate and multivariate Cox regression analyses were used to explore the prognostic risk factors of NSCLC patients.Results The area under the ROC curve of SII/ALB before treatment was 0.834, and the corresponding cut-off value was 17.79, so the patients were divided into low SII/ALB group (≤17.79) and high SII/ALB group (>17.79). The pretreatment SII/ALB ratio was correlated with the type of lung cancer, ECOG PS score, stage, number of immunotherapy lines, treatment regimen, adverse reactions, and neutrophil indexes (P<0.05). The median progression-free survival (mPFS) of patients in the low SII/ALB group was significantly longer than that in the high SII/ALB group (P<0.001). The objective response rate (ORR) and disease control rate (DCR) in the low SII/ALB group were significantly higher than those in the high SII/ALB group (ORR:35.14% vs. 9.76%, P=0.007; DCR: 72.97% vs. 39.02%, P=0.003). NRS score (HR=0.327, 95% CI: 0.146~0.736, P=0.007), stage (HR=0.061, 95% CI: 0.021~0.183, P<0.001) and SII/ALB (HR=0.026, 95% CI: 0.009~0.075, P<0.001) were independent prognostic risk factors for PFS.Conclusion SII/ALB could be an important biological marker for predicting the prognosis of NSCLC patients treated with opioids and ICIs.