营养代谢状态与恶性肿瘤患者的免疫功能状态及免疫治疗应答效率(包括治疗相关毒性耐受能力)存在动态交互 关系,且与恶性肿瘤患者免疫治疗预后具有密切相关性。 宏观上,肿瘤相关代谢紊乱(包括宿主抗肿瘤应激反应及癌源性代 谢异常)引发蛋白质-能量消耗失衡伴摄食减少及活动受限,导致机体进行性营养不良甚至恶液质,进一步降低免疫治疗应答 率及治疗耐受性。 微观上,营养匮乏、缺氧及酸中毒的肿瘤微环境通过干扰免疫细胞代谢重编程,抑制其抗肿瘤效能,形成免 疫逃逸恶性循环。 营养状态评估是肿瘤免疫治疗前基线评估中的重要一环,能更精准定位可以从免疫治疗中获益的人群,为 其提供更加个体化的治疗方案。 因此,预后营养指数(PNI)、老年营养风险指数(GNRI) 等反映营养状态和免疫功能的指 标,成为预测恶性肿瘤患者免疫治疗预后的潜在标志物。 本文总结了肿瘤患者营养代谢特点及其对免疫功能的影响,以及营 养指标对恶性肿瘤患者免疫治疗预后预测的研究进展,旨在为临床实践提供一定参考价值。

Nutritional and metabolic status demonstrates dynamic interplay with immune function status and immunotherapy efficacy including treatment - related toxicity tolerance in cancer patients and shows significant correlation with immunotherapy prognosis. Macroscopically tumor-associated metabolic disorders encompassing host anti-tumor stress responses and cancer-derived metabolic abnormalities trigger protein - energy wasting imbalance accompanied by reduced dietary intake and activity restriction leading to progressive malnutrition or even cachexia which further diminishes immunotherapy response rates and treatment tolerance. Microscopically the nutrient - deprived hypoxic and acidotic tumor microenvironment disrupts immune cell metabolic reprogramming thereby suppressing their antitumor efficacy and establishing a vicious cycle of immune escape. Nutritional assessment constitutes a crucial component of baseline evaluation prior to cancer immunotherapy enabling clinicians to better identify beneficiaries from immunotherapy and formulate personalized treatment strategies. Consequently prognostic indicators integrating nutritional and immune parameters e. g. prognostic nutritional index geriatric nutritional risk index have emerged as potential biomarkers for predicting immunotherapy outcomes. This review synthesizes current understanding of cancer-associated metabolic characteristics their immunomodulatory impacts and advances in nutritional biomarkers for immunotherapy prognosis prediction aiming to provide clinical reference value.