目的 探讨非小细胞肺癌(NSCLC)患者泛免疫炎症指数(PIV)、T细胞亚群比例及MAX二聚化蛋白(MGA)基因突变特征及对接受化疗联合局部热疗临床转归预测价值。方法 选取2020年4月至2024年4月江汉大学附属湖北省第三人民医院收治的332例NSCLC患者,所有患者均接受含铂双药化疗方案联合局部热疗,共进行4~6个周期的联合治疗。依据患者启动治疗后1年内的临床转归情况分为存活组和死亡组。对比两组患者的一般临床资料、NSCLC病理特征及治疗特征、外周血炎症指标、T细胞亚群比例、MGA基因突变情况,采用Logistic回归模型分析患者不良临床转归的危险因素,绘制受试者操作特征(ROC)曲线分析各危险因素独立及联合预测患者不良临床转归的临床价值。结果 入组患者中1年内死亡201例(60.5%)。死亡组年龄、合并糖尿病、肿瘤直径、非鳞癌患者、低分化患者、Ⅳ期患者、中性粒细胞/淋巴细胞比值(NLR)、系统免疫炎症指数(SII)、PIV、CD8+T细胞、MGA基因突变阳性均高于存活组患者,化疗周期数、CD4+细胞、CD4+/CD8+比值低于存活组(P<0.05)。多因素Logistic回归分析表明PIV、CD4+T细胞、CD4+/CD8+比值、MGA基因突变阳性均与患者不良临床转归相关(P<0.05)。上述4种指标独立及联合预测患者临床转归不良结局的AUC值分别为0.642、0.607、0.625、0.572、0.788。校准曲线提示模型拟合度良好、决策曲线显示阈值概率0~90%内模型预测净获益>0。结论 PIV、CD4+细胞比例、CD4+/CD8+比值、MGA基因突变阳性均与接受化疗联合局部热疗的NSCLC患者不良临床转归相关,联合应用对于预测患者治疗预后具有较高的临床价值。
Abstract
Objective To investigate the characteristics of pan-immune-inflammation value (PIV), T cell subset proportions, and MAX dimerization protein (MGA) gene mutations in patients with non-small cell lung cancer (NSCLC), as well as their predictive value for the clinical outcomes of patients receiving chemotherapy combined with local hyperthermia. Method A total of 332 NSCLC patients admitted to Hubei Third People's Hospital Affiliated to Jianghan University from April 2020 to April 2024 were selected. All patients received a platinum-based dual-drug chemotherapy regimen combined with local hyperthermia, with a total of 4 to 6 cycles of combined treatment. Based on the clinical outcomes within 1 year after the initiation of treatment, the patients were divided into the survival group and the death group. General clinical data, pathological characteristics of NSCLC, treatment characteristics, peripheral blood inflammatory indicators, T cell subset proportions, and MGA gene mutation status were compared between the two groups. Logistic regression model was used to analyze the risk factors for adverse clinical outcomes in patients, and receiver operating characteristic (ROC) curves were plotted to analyze the clinical value of each risk factor in predicting adverse clinical outcomes independently and in combination. Result Among the enrolled patients, 201 (60.5%) died within one year. Compared with the survival group, the death group had higher values in terms of age, proportion of patients complicated with diabetes mellitus, tumor diameter, proportion of non-squamous cell carcinoma patients, proportion of patients with poor differentiation, proportion of stage Ⅳ patients, neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), PIV, CD8+T cell count, and proportion of positive MGA gene mutations, while lower values in the number of chemotherapy cycles, CD4+T cell count, and CD4+T cell/CD8+T cell ratio (all P<0.05). Logistic regression analysis showed that PIV, CD4+T cell count, CD4+T cell/CD8+T cell ratio, and positive MGA gene mutation were all associated with adverse clinical outcomes in patients (all P<0.05). The area under the curve (AUC) values of these four indicators for predicting adverse clinical outcomes independently and in combination were 0.642, 0.607, 0.625, 0.572, and 0.788, respectively. The calibration curve indicated that the model had a good degree of fit, and the decision curve showed that the model had a net benefit > 0 within the threshold probability range of 0-90%. Conclusion PIV, CD4+T cell proportion, CD4+/CD8+ratio, and positive MGA gene mutation are all associated with adverse clinical outcomes in NSCLC patients receiving chemotherapy combined with local hyperthermia. The combined application of these indicators has high clinical value for predicting the treatment prognosis of patients.
关键词
非小细胞肺癌 /
化疗 /
局部热疗 /
联合治疗 /
泛免疫炎症指数 /
T细胞亚群比例 /
MAX二聚化蛋白基因 /
临床转归
Key words
Non-small cell lung cancer /
Chemotherapy /
Local hyperthermia /
Combined therapy /
Pan-immune-inflammation value /
T cell subset proportion /
MAX dimerization protein gene /
Clinical outcome
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