年龄校正查尔森合并症指数用于评估晚期非小细胞肺癌患者免疫治疗预后的价值

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摘要目的探索年龄校正查尔森合并症指数(ACCI)用于评估晚期非小细胞肺癌(NSCLC)免疫治疗预后的价值。方法回顾分析2021年1月1日—2022年12月31日在复旦大学附属中山医院厦门医院接受免疫检查点抑制剂(ICIs)治疗的110例NSCLC患者临床资料,利用ACCI量表进行ACCI评分,以ACCI评分中位数为截断值,将患者分为低ACCI评分组及高ACCI评分组,比较2组患者ICIs治疗效果。采用单因素和多因素Cox回归模型分析影响NSCLC患者预后的因素。结果 110例NSCLC患者中,ACCI评分最低3分、最高13分,中位评分7分。将ACCI评分<7分患者纳入低ACCI评分组(41例)、ACCI评分≥7分纳入高ACCI评分组(69例),2组患者除病理类型、分期、中性粒细胞淋巴细胞比例(NLR)、美国东部肿瘤协作组体能状态(ECOG-PS)评分外,其他一般特征差异均无统计学意义。低和高ACCI评分组患者治疗反应差异无统计学意义(P ＞0.05),但低ACCI评分组患者中位无进展生存期较高ACCI评分组明显延长(15个月vs 11.5个月,P=0.035);低ACCI评分组患者中位总生存期较高ACCI评分组有延长趋势,但差异无统计学意义(P=0.071)。单因素Cox回归分析结果显示,NLR和Ⅳ期与NSCLC患者PFS有关,而ECOG-PS评分、NLR与NSCLC患者OS有关。多因素Cox回归分析结果显示,NLR [风险比(HR)=1.249,95%CI:(1.148, 1.360),P<0.001]、ECOG-PS评分[HR=2.544,95%CI:(1.126,5.748),P=0.025]与更长OS相关,而NLR [HR=1.176,95%CI:(1.097,1.262),P<0.001)]是接受免疫治疗的NSCLC患者PFS的独立预测因子。结论在接受ICIs治疗的NSCLC患者中,低ACCI评分组患者PFS明显延长,且中位OS有延长趋势,但ACCI不是预测NSCLC患者免疫治疗预后的指标。NLR和ECOG-PS评分与NSCLC患者更长OS相关,而NLR是接受免疫治疗的NSCLC患者PFS的独立预测因子。　

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关键词 ：非小细胞肺癌, 年龄校正查尔森合并症指数, 免疫治疗, 预后

Abstract：Objective To explore the value of the age-adjusted Charlson comorbidity index (ACCI) in evaluating the prognosis of immunotherapy for advanced non-small cell lung cancer (NSCLC). Methods The clinical data of 110 patients with NSCLC who received immune checkpoint inhibitors (ICIs) in Zhongshan Hospital (Xiamen), Fudan University from January 1, 2021, to December 31, 2022, were retrospectively analyzed. The patients were divided into a low ACCI score group and a high ACCI score group by ACCI scale, and the treatment effect of ICIs was compared between the two groups. Univariate and multivariate Cox regression models were used to analyze the factors affecting the prognosis of NSCLC patients. Results Among the 110 NSCLC patients, the ACCI score was the lowest 3, the highest was 13, and the median score was 7. The patients with ACCI score<7 were included in a low ACCI score group (41 cases) and ACCI score ≥ 7 points were included in a high ACCI score group (69 cases). There were no significant differences in the general characteristics between the two groups, except for pathological type, stage, neutrophil-lymphocyte ratio (NLR), and performance status of the Eastern Cooperative Oncology Group (ECOG-PS) between the two groups. There was no significant difference in treatment response between the low and high ACCI groups (P>0.05), but the median progression-free survival was higher in the low ACCI group and significantly longer in the ACCI group (15months vs 11.5 months, P=0.035). The median overall survival of patients in the low ACCI score group was higher, and there was a prolongation trend in the ACCI score group, but the difference was not statistically significant (P=0.071). The results of univariate Cox regression analysis showed that NLR and stage IV were associated with PFS in NSCLC patients, while ECOG-PS score and NLR were associated with OS in NSCLC patients. Multivariate Cox regression analysis showed that NLR , ECOG-PS score was associated with longer OS, while NLR was an independent predictor of PFS in NSCLC patients receiving immunotherapy. Conclusions Among NSCLC patients treated with ICIs, PFS was significantly prolonged in the low ACCI score group, and the median OS tended to be prolonged, but ACCI was not a predictor of immunotherapy prognosis in NSCLC patients. NLR and ECOG-PS scores are associated with longer OS in NSCLC patients, and NLR is an independent predictor of PFS in NSCLC patients receiving immunotherapy.

Key words： Non-small cell lung cancer (NSCLC) Age-adjusted Charlson comorbidity index (ACCI) Immunotherapy Prognosis

收稿日期: 2023-10-27

ZTFLH:

R734.2

作者简介: 张清伟(1992—),男,福建晋江人,住院医师,硕士研究生,主要从事肺部感染性疾病及肺部肿瘤的诊疗。

引用本文:

张清伟,许毅娇,杨舒雯,陈志盛,肖雄. 年龄校正查尔森合并症指数用于评估晚期非小细胞肺癌患者免疫治疗预后的价值[J]. 中国校医, 2023, 37(12): 919-924.
ZHANG Qingwei, XU Yijiao, YANG Shuwen, CHEN Zhisheng, XIAO Xiong. Value of age-adjusted Charlson comorbidity index (ACCI) in evaluating immunotherapy prognosis in patients with advanced non-small cell lung cancer (NSCLC). Chinese Journal of School Doctor, 2023, 37(12): 919-924.

链接本文:

https://www.zgxyzz.org.cn/CN/ 或 https://www.zgxyzz.org.cn/CN/Y2023/V37/I12/919

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