目的 探究预后营养指数(PNI)与中性粒细胞-淋巴细胞比值(NLR)和淋巴细胞-单核细胞比值(LMR)对 PD-1 / PD-L1 抑制剂治疗非小细胞肺癌(NSCLC)疗效的评价及分析预后相关因素。 方法 根据纳入排除标准选取 2018 年 1 月至 2022 年 5 月在华南理工大学附属第六医院肿瘤一区收治的 NSCLC 患者 78 例临床资料进行回顾性研究。 均采取 PD- 1 / PD-L1 抑制剂治疗,收集基线资料并进行随访。 分析不同疗效 NSCLC 患者[疾病完全缓解(CR)13 例、疾病部分缓解(PR)33 例、疾病稳定(SD)17 例、疾病进展(PD)15 例]NLR、LMR、PNI 的差异,并通过中位数将 NLR、LMR、PNI 进行高低分组,分析不 同术前 NLR、LMR、PNI 的 NSCLC 患者疗效等级差异。 根据随访资料将患者划分为生存组(42 例)与死亡组(42 例),比较两 组单因素的差异,通过 Cox 回归分析预后影响因素,并采用 ROC 曲线分析 NLR、LMR、PNI 预测 NSCLC 患者预后价值。 结果 不同疗效 NSCLC 患者术前 NLR、LMR、PNI 比较差异存在统计学意义(P<0. 05)。 低 NLR 组、高 LMR 组、高 PNI 组 PD-1 / PD-L1 抑制剂治疗有效率与疾病控制率较高 NLR 组、低 LMR 组、低 PNI 组更高(P<0. 05)。 Cox 回归分析显示,高 NLR、低 LMR、低 PNI 为影响 NSCLC 预后危险因素,治疗干预时间小于三线、ECOG 评分 0~ 1 分为影响 NSCLC 患者预后保护因素(P< 0. 05)。 ROC 曲线分析显示,NLR、LMR、PNI 预测 NSCLC 患者预后的 AUC 分别为 0. 880、0. 823、0. 907,均具有较好准确性。 三项联合数据预测中央区淋巴结转移 AUC 分别为 0. 934,准确性更高。 NLR、LMR、PNI 与三项联合 AUC 比较 Z 值分别为 0. 811、2. 061、1. 1248。 结论 PNI、NLR、LMR 评估 PD-1 / PD-L1 抑制剂治疗 NSCLC 疗效具有较好价值,高 NLR、低 LMR、低 PNI 为影响预后危险因素,治疗干预时间小于三线、ECOG 评分 0~ 1 分为预后保护因素,且 NLR、LMR、PNI 可作为 NSCLC 患者 预后预测指标,且联合预测效果更好。

Objective To investigate the effect of prognostic nutritional index PNI neutrophil - lymphocyte ratio NLR and lymphocyte-monocyte ratio LMR on the efficacy of PD-1/ PD-L1 inhibitors in the treatment of non-small cell lung cancer NSCLC . Evaluation and analysis of prognostic factors. Method According to the inclusion and exclusion criteria the clinical data of 78 patients with NSCLC who were admitted to The Sixth Affiliated Hospital of South China University of Technology / Tumor District 1 from January 2018 to May 2022 were selected for retrospective study. All patients were treated with PD-1/ PD-L1 inhibitor and baseline data were collected and followed up. The differences of NLR LMR and PNI in NSCLC patients with different curative effects were analyzed and NLR LMR and PNI were divided into high and low groups by the median and the differences in curative effect grades of NSCLC patients with different preoperative NLR LMR and PNI were analyzed. According to the follow-up waterlogging the patients were divided into survival group and death group and the univariate differences between the two groups were compared. The prognostic factors were analyzed by binary Logistic regression and the ROC curve was used to analyze the prognostic value of NLR LMR and PNI in NSCLC patients. Result There were significant differences in preoperative NLR LMR and PNI in NSCLC patients with different curative effects P<0. 05 The comparison of NLR values in CR group PR group >SD group >PD group P<0. 05 . The effective rate and disease control rate of PD-1/ PD-L1 inhibitor in low NLR group high LMR group and high PNI group were higher than those in NLR group low LMR group and low PNI group P< 0. 05 . Binary Logistic regression analysis showed that high NLR low LMR and low PNI were prognostic risk factors and treatment intervention time less than third-line and ECOG score 0-1 were prognostic protective factors P<0. 05 . ROC curve analysis showed that the AUCs of NLR LMR and PNI for predicting the prognosis of NSCLC patients were 0. 880 0. 823 and 0. 907 respectively all with good accuracy. The three combined data predicted 0. 934 respectively with higher accuracy. The Z values between NLR LMR PNI and the three combined AUC were 0. 811 2. 061 and 1. 1248 respectively. Conclusion PNI NLR and LMR have good value in evaluating the efficacy of PD-1/ PD-L1 inhibitors in the treatment of NSCLC. High NLR low LMR and low PNI are prognostic risk factors. The treatment intervention time is less than the third-line and the ECOG score is 0-1. Prognostic protective factors and NLR LMR and PNI can be used as prognostic indicators for patients with NSCLC And the combined prediction effect is better.