目的 探讨控制营养状态(CONUT)、系统免疫炎症指数(SII)、中性粒细胞与淋巴细胞比值(NLR)和血小板与淋巴 细胞比值(PLR)对局部晚期或转移性食管鳞癌患者应用免疫治疗疗效的预测价值,以及联合上述 4 项指标的预测效能。 方法 回顾性分析山东省肿瘤医院和高密市人民医院 2018 年 1 月至 2021 年 12 月间应用免疫联合化疗或放化疗治疗的食管鳞癌患 者。 收集患者治疗前 1 周内的血液学检查结果,计算患者的 CONUT 评分、SII、NLR 及 PLR 值。 以 1 年总生存(OS)绘制受试 者操作特征(ROC)曲线,计算 CONUT、SII、NLR 和 PLR 的最佳截断点。 主要观察终点为 OS,次要观察终点为无进展生存 (PFS)和客观缓解率(ORR)。 结果 总共入组 335 例患者,根据 ROC 曲线,得到 CONUT、SII、NLR 及 PLR 的截断点分别为 2. 5、 749. 69、2. 795 及 202. 975。 低 COUNT 和高评分患者的中位 OS 期分别为 27. 3(22. 9 ~ 31. 7)个月和 23. 3(16. 29 ~ 30. 25)个 月(P < 0. 001),PFS 期分别为 10. 9(9. 96 ~ 11. 84)个月和 7. 6(6. 51 ~ 8. 63)个月(P = 0. 001)。 低 SII 和高 SII 患者的中位 OS 期分别为 27. 9(25. 12 ~ 30. 68)个月和 17. 9(16. 99 ~ 18. 81)个月(P < 0. 001),PFS 期分别为 11. 6(10. 69 ~ 12. 51)个月 和 7. 5(6. 56 ~ 8. 44)个月(P < 0. 001)。 低 NLR 和高 NLR 患者的中位 OS 期分别为 28. 37( 25. 25 ~ 31. 49) 个月和 18. 6 (16. 20 ~ 21. 0)个月(P = 0. 016),PFS 期分别为 10. 93(9. 96 ~ 11. 90)个月和 7. 53(6. 80 ~ 8. 26)个月(P < 0. 001)。 低 PLR 和高 PLR 患者的中位 OS 期分别为 27. 5(23. 7 ~ 31. 3)个月和 21. 0(14. 3 ~ 27. 7)个月(P = 0. 007),PFS 期分别为 10. 9 (9. 9 ~ 11. 9)个月和 8. 3(7. 5 ~ 9. 2)个月(P < 0. 001)。 四项指标的联合预测效能较单一 CONUT 评分更高。 结论 局部晚期 或转移性食管鳞癌应用免疫治疗的患者,治疗前低 CONUT 评分的患者 OS 期和 PFS 期均优于高评分的患者,且联合炎症指标 的预测价值更优。

Objective To explore the controlling nutritional status CONUT and systemic immune - inflammatory index SII neutrophil-lymphocyte ratio NLR and platelet-lymphocyte ratio ratio PLR in predicting the efficacy of immunotherapy in patients with locally advanced or metastatic esophageal squamous cell carcinoma and the predictive efficacy of combining the above four indicators. Method Patients with esophageal squamous cell carcinoma treated with immune combined chemotherapy or chemoradiotherapy in Cancer Hospital of Shandong First Medical University and Gaomi People 's Hospital from January 2018 to December 2021 were retrospectively analyzed. The hematological examination results of the patients within 1 week before treatment were collected and the CONUT score SII NLR and PLR values of the patients were calculated. The dependent receiver operating characteristic curve ROC curve was drawn based on one-year overall survival and the best cut-off values of CONUT SII NLR and PLR were calculated. The primary end point was overall survival OS and the secondary end points were progression-free survival PFS and objective response rate ORR . Result A total of 335 patients were enrolled. According to the ROC curve the cut-off values of CONUT SII NLR and PLR were 2. 5 749. 69 2. 795 and 202. 975 respectively. The median OS was 27. 3 22. 9-31. 7 months in the low COUNT group and 23. 3 16. 29-30. 25 months in the high COUNT group P < 0. 001 . The median PFS was 10. 9 9. 96-11. 84 months in the low count group and 7. 6 6. 51-8. 63 months in the high count group P = 0. 001 . The median OS of the low SII group and the high SII group were 27. 9 25. 12 - 30. 68 months and 17. 9 16. 99 - 18. 81 months P < 0. 001 respectively. The median PFS of the low SII group and the high SII group were 11. 6 10. 69-12. 51 months and 7. 5 (6. 56-8. 44) months P < 0. 001 respectively. The median OS of the low NLR group and the high NLR group were 28. 37 25. 25-31. 49 months and 18. 6 16. 20-21. 0 months respectively P = 0. 016 . The PFS was 10. 93 9. 96-11. 90 months and 7. 53 6. 80-8. 26 months respectively P < 0. 001 . The median OS of the low PLR group and the high PLR group were 27. 5 23. 7-31. 3 and 21. 0 14. 3-27. 7 months respectively P = 0. 007 and the median PFS were 10. 9 9. 9 - 11. 9 and 8. 3 7. 5 - 9. 2 months respectively P < 0. 001 . The combined prediction efficiency of the four indicators was higher than that of the single CONUT score. Conclusion For patients with locally advanced or metastatic esophageal squamous cell carcinoma treated with immunotherapy patients with low CONUT score before treatment have better OS and PFS than those with high CONUT score and the predictive value of combined inflammation indicators is better.