Correlation between the pulmonary immune prognostic index and prognosis of advanced non-small cell lung cancer patients treated with sintilimab
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摘要:目的
分析肺免疫预后指数(LIPI)与信迪利单抗治疗晚期非小细胞肺癌(NSCLC)患者预后的相关性。
方法选取145例晚期NSCLC患者作为研究对象。所有患者行信迪利单抗治疗, 记录患者的临床资料。根据LIPI, 将患者分为LIPI低风险组、LIPI中风险组和LIPI高风险组。分析LIPI与晚期NSCLC患者预后的相关性。筛选患者无进展生存期(PFS)和总生存期(OS)的影响因素。
结果单因素分析显示，患者年龄、是否吸烟、病理类型、临床分期和LIPI是PFS的影响因素(P < 0.05); 年龄、病理类型、临床分期和LIPI是OS的影响因素(P < 0.05)。多因素Cox回归分析显示，年龄60~70岁、年龄＞70岁、腺癌、分期Ⅳ期、LIPI高风险是患者PFS预后的独立影响因素(P < 0.05); 年龄＞70岁、分期Ⅳ期、腺癌、LIPI高风险是患者OS预后的独立影响因素(P < 0.05)。LIPI低风险、中风险和高风险影响患者预后。LIPI低风险患者预后更佳，中位PFS、OS更长。
结论LIPI与信迪利单抗治疗晚期NSCLC患者的预后具有相关性。LIPI低风险晚期NSCLC患者在信迪利单抗治疗中获益更多。
Abstract:ObjectiveTo analyze the correlation between the pulmonary immune prognostic index (LIPI) and the prognosis of patients with advanced non-small cell lung cancer (NSCLC) treated with sintilimab.
MethodsA total of 145 patients with advanced NSCLC were selected as study subjects. All patients received treatment with sintilimab, and their clinical baseline data were recorded. According to the LIPI score, patients were divided into low-risk, intermediate-risk, and high-risk groups. The correlation between LIPI and the prognosis of advanced NSCLC patients was analyzed. Factors influencing progression-free survival (PFS) and overall survival (OS) were identified.
ResultsUnivariate analysis showed that patient age, smoking status, pathological type, clinical stage and LIPI were factors affecting PFS (P < 0.05); age, pathological type, clinical stage and LIPI were factors affecting OS (P < 0.05). Multivariate Logistic regression analysis revealed that age of 60 to 70 years, age > 70 years, adenocarcinoma, stage Ⅳ and high-risk LIPI were independent prognostic factors of PFS (P < 0.05); age > 70 years, poor stage Ⅳ, adenocarcinoma and high-risk LIPI were independent prognostic factors of OS (P < 0.05). LIPI influenced patient's prognosis, with low-risk patients showing better outcomes and longer median PFS and OS.
ConclusionLIPI is correlated with the prognosis of advanced NSCLC patients treated with sintilimab. Patients with a low-risk LIPI assessment benefit more from sintilimab treatment.
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表 1 145例晚期NSCLC患者的临床资料[n(%)]
资料 分类 数据 性别 男 115(79.3) 女 30(20.7) 年龄 < 60岁 25(17.2) 60~70岁 60(41.4) >70岁 60(41.4) 吸烟史 否 62(42.8) 是 83(57.2) 病理类型 鳞癌 91(62.8) 腺癌 54(37.2) 分期 Ⅲ期 20(13.8) Ⅳ期 125(86.2) 
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表 2 NSCLC患者临床病理特征与LIPI的关系[n(%)]
资料 分类 n LIPI低风险组(n=42) LIPI中风险组(n=73) LIPI高风险组(n=30) χ2 P 年龄 ＜60岁 25 9(21.4) 13(17.8) 3(10.0) 4.132 0.388 60~70岁 60 18(42.9) 32(43.8) 10(33.3) ＞70岁 60 15(35.7) 28(38.4) 17(56.7) 性别 男 115 31(73.8) 60(82.2) 24(80.0) 1.153 0.562 女 30 11(26.2) 13(17.8) 6(20.0) 吸烟 是 83 20(47.6) 46(63.0) 17(56.7) 2.134 0.344 否 62 22(52.4) 27(37.0) 13(43.3) 病理类型 腺癌 54 11(26.2) 24(32.9) 19(63.3) 11.528 0.003 鳞癌 91 31(73.8) 49(67.1) 11(36.7) 临床分期 Ⅲ期 20 8(19.0) 9(12.3) 3(10.0) 1.388 0.500 Ⅳ期 125 34(81.0) 64(87.7) 27(90.0) LIPI: 肺免疫预后指数。
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表 3 患者预后的单因素分析
资料 分类 n 中位
PFS/月95%CI χ2 P 中位
OS/月95%CI χ2 P 年龄 ＜60岁 25 8.0 6.541~9.459 6.777 0.034 15.0 11.912~18.088 7.598 0.022 60~70岁 60 6.0 5.064~6.936 10.0 8.921~11.097 ＞70岁 60 5.0 4.331~5.669 8.0 6.226~9.774 性别 男 115 5.0 4.369~5.631 1.479 0.224 9.0 8.138~9.862 0.882 0.348 女 30 7.0 5.466~8.535 12.0 6.225~17.775 吸烟 是 83 5.0 4.335~5.665 5.034 0.025 9.0 8.037~9.963 1.043 0.307 否 62 6.0 4.940~7.060 10.0 7.461~12.539 病理类型 腺癌 54 3.0 2.280~3.720 18.537 < 0.001 7.0 4.601~9.399 15.966 < 0.001 鳞癌 91 6.5 5.813~7.187 10.0 6.946~13.055 临床分期 Ⅲ期 20 8.0 5.078~10.922 7.638 0.006 NAa NAa 11.596 < 0.001 Ⅳ期 125 5.0 4.345~5.655 9.0 8.130~9.870 LIPI 低风险 42 8.0 6.847~9.153 56.250 < 0.001 15.0 12.242~17.757 36.651 < 0.001 中风险 73 6.0 5.172~6.828 10.0 8.864~11.136 高风险 30 2.0 1.270~2.730 5.0 3.470~6.530 LIPI: 肺免疫预后指数; OS: 总生存期; PFS: 无进展生存期; NAa: 数据有缺失。
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表 4 患者PFS影响因素的多因素Cox回归分析
临床资料 分类 β SE Wald HR 95%CI P 年龄 ＜60岁 — — — 1 — — 60~70岁 0.696 0.260 7.158 2.006 1.205~4.341 0.007 ＞70岁 0.597 0.271 4.480 1.816 1.067~3.091 0.028 性别 男 — — — 1 — — 女 0.391 0.226 3.001 0.676 0.434~1.053 0.083 吸烟 是 — — — 1 — — 否 0.325 0.189 2.941 1.384 0.955~2.006 0.086 病理类型 鳞癌 — — — 1 — — 腺癌 0.753 0.199 14.276 2.123 1.437~3.138 < 0.001 临床分期 Ⅲ期 — — — 1 — — Ⅳ期 0.800 0.257 9.684 2.225 1.345~3.683 0.002 LIPI 低风险 — — — 1 — — 中风险 0.083 0.249 0.111 1.807 0.667~1.772 0.783 高风险 1.027 0.271 7.335 2.792 1.328~5.870 0.007
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表 5 患者OS影响因素的多因素Cox回归分析
资料 分类 β SE Wald HR 95%CI P 年龄 ＜60岁 — — — 1 — — 60~70岁 0.327 0.302 1.170 1.386 0.767~2.505 0.279 ＞70岁 0.640 0.323 3.936 1.896 1.008~3.569 0.047 性别 男 — — — 1 — — 女 0.206 0.255 0.651 0.814 0.494~1.342 0.420 吸烟 是 — — — 1 — — 否 0.086 0.208 1.171 1.090 0.725~1.638 0.679 病理类型 鳞癌 — — — 1 — — 腺癌 0.455 0.210 4.713 1.576 1.045~2.377 0.030 临床分期 Ⅲ期 — — — 1 — — Ⅳ期 1.108 0.375 8.730 3.030 1.452~6.320 0.003 LIPI 低风险 — — — 1 — — 中风险 0.367 0.249 2.165 1.443 0.885~2.351 0.141 高风险 1.122 0.308 13.235 3.071 1.678~5.620 < 0.001
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