山东大学学报 (医学版) ›› 2024, Vol. 62 ›› Issue (6): 48-53.doi: 10.6040/j.issn.1671-7554.0.2024.0267
• 临床医学 • 上一篇
田丽君1,桑玉洁1,孙瑜婧1,韩冰1,秦成勇2,祁建妮3
TIAN Lijun1, SANG Yujie1, SUN Yujing1, HAN Bing1, QIN Chengyong2, QI Jianni3
摘要: 目的 探讨全身免疫炎症指数(systemic-immune inflammation index, SII)对原发性肝癌(primary liver cancer, PLC)患者免疫检查点抑制剂(immune checkpoint inhibitors, ICIs)治疗相关不良反应的预测价值。 方法 选取2022年1月至2023年10月期间收治的接受ICIs治疗的162例PLC患者,按照是否发生免疫相关不良反应(immune-related adverse events, irAEs)分为irAEs组和非irAEs组。收集并比较两组的临床资料,采用多因素Logistic回归分析接受ICIs治疗的PLC患者发生irAEs的影响因素。绘制受试者工作特征(receiver operating characteristic, ROC)曲线评价SII对ICIs治疗后的PLC患者发生irAEs的预测价值。 结果 162例接受ICIs治疗的PLC患者中发生irAEs 77例(47.53%),其中单一性irAEs 74例,以内分泌毒性最常见(13.58%);多重性irAEs 3例,以肝脏毒性结合皮肤毒性最常见(1.23%)。多因素Logistic回归分析结果显示,既往自身免疫疾病史、IL-6、SII是影响接受ICIs治疗的PLC患者发生irAEs的独立危险因素(P<0.05)。ROC曲线分析结果显示:IL-6、SII预测接受ICIs治疗的PLC患者发生irAEs的曲线下面积分别为0.693(95%CI:0.589~0.797)、0.816(95%CI:0.732~0.900)。最佳截断值为1 336.8×109/L时,SII预测灵敏度和特异度分别为87.76%和63.65%。 结论 SII预测接受ICIs治疗的PLC患者发生irAEs具有良好价值,且是影响接受ICIs治疗的PLC患者发生irAEs的独立危险因素。
中图分类号:
[1] Rumgay H, Arnold M, Ferlay J, et al. Global burden of primary liver cancer in 2020 and predictions to 2040[J]. J Hepatol, 2022, 77(6): 1598-1606. [2] Liu Y, Zheng JX, Hao JL, et al. Global burden of primary liver cancer by five etiologies and global prediction by 2035 based on global burden of disease study 2019[J]. Cancer Med, 2022, 11(5): 1310-1323. [3] Zheng YM, Wang SW, Cai JB, et al. The progress of immune checkpoint therapy in primary liver cancer[J]. Biochim Biophys Acta Rev Cancer, 2021, 1876(2): 188638. [4] Darnell EP, Mooradian MJ, Baruch EN, et al. Immune-related adverse events(irAEs): diagnosis, management, and clinical pearls[J]. Curr Oncol Rep, 2020, 22(4): 39. [5] Wang E, Kraehenbuehl L, Ketosugbo K, et al. Immune-related cutaneous adverse events due to checkpoint inhibitors[J]. Ann Allergy Asthma Immunol, 2021, 126(6): 613-622. [6] Xie RJ, Liu XZ, Wu HY, et al. Associations between systemic immune-inflammation index and abdominal aortic calcification: results of a nationwide survey[J]. Nutr Metab Cardiovasc Dis, 2023, 33(7): 1437-1443. [7] Tian BW, Yang YF, Yang CC, et al. Systemic immune-inflammation index predicts prognosis of cancer immunotherapy: systemic review and meta-analysis[J]. Immunotherapy, 2022, 14(18): 1481-1496. [8] Nakamoto S, Ohtani Y, Sakamoto I, et al. Systemic immune-inflammation index predicts tumor recurrence after radical resection for colorectal cancer[J]. Tohoku J Exp Med, 2023, 261(3): 229-238. [9] 施国明, 黄晓勇, 任正刚, 等. 肝癌免疫检查点抑制剂相关不良反应管理中国专家共识(2021版)[J]. 中华消化外科杂志, 2021, 20(12): 1241-1258. SHI Guoming, HUANG Xiaoyong, REN Zhenggang, et al. Chinese expert consensus on the management of immune-related adverse events of hepato-cellular carcinoma treated with immune checkpoint inhibitors(2021 edition)[J]. Chinese Journal of Digestive Surgery, 2021, 20(12): 1241-1258. [10] Geraghty JR, Lung TJ, Hirsch Y, et al. Systemic immune-inflammation index predicts delayed cerebral vasospasm after aneurysmal subarachnoid hemorrhage[J]. Neurosurgery, 2021, 89(6): 1071-1079. [11] Muntyanu A, Netchiporouk E, Gerstein W, et al. Cutaneous Immune-Related Adverse Events(irAEs)to Immune Checkpoint Inhibitors: a Dermatology Perspective on Management[J]. J Cutan Med Surg, 2021, 25(1): 59-76. [12] Ramos-Casals M, Flores-Chávez A, Brito-Zerón P, et al. Immune-related adverse events of cancer immunotherapies targeting kinases[J]. Pharmacol Ther, 2022, 237: 108250. doi:10.1016/j.pharmthera.2022.108250. [13] Zou R, Hao YH, Wang YY, et al. A multicenter retrospective analysis: factors influencing hepatic adverse events induced by immunotherapy in advanced liver cancer[J]. Cancer Rep, 2024, 7(2): e1918. doi:10.1002/cnr2.1918. [14] 乔师师, 郭化虎, 杨振, 等. 晚期肝细胞癌免疫治疗的相关不良反应[J]. 广东医学, 2023, 44(3): 369-373. QIAO Shishi, GUO Huahu, YANG Zhen, et al. Adverse reactions related to immunotherapy for advanced hepatocellular carcinoma[J]. Guangdong Medical Journal, 2023, 44(3): 369-373. [15] Faak F, Buni M, Falohun A, et al. Selective immune suppression using interleukin-6 receptor inhibitors for management of immune-related adverse events[J]. J Immunother Cancer, 2023, 11(6): e006814. doi:10.1136/jitc-2023-006814. [16] Ke WH, Zhang L, Dai Y. The role of IL-6 in immunotherapy of non-small cell lung cancer(NSCLC)with immune-related adverse events(irAEs)[J]. Thorac Cancer, 2020, 11(4): 835-839. [17] 王汉萍. 肝癌免疫检查点抑制剂治疗相关不良反应及处理[J]. 临床肝胆病杂志, 2022, 38(5): 985-991. WANG Hanping. Adverse reactions associated with immune checkpoint inhibitor in treatment of liver cancer and related treatment measures[J]. Journal of Clinical Hepatology, 2022, 38(5): 985-991. [18] Dimitriou F, Hogan S, Menzies AM, et al. Interleukin-6 blockade for prophylaxis and management of immune-related adverse events in cancer immunotherapy[J]. Eur J Cancer, 2021, 157: 214-224. doi:10.1016/j.ejca.2021.08.031. [19] Li J, Shi HY, Zhou M. Correlation between preoperative systemic immune inflammation index, nutritional risk index, and prognosis of radical resection of liver cancer[J]. World J Gastrointest Surg, 2023, 15(11): 2445-2455. [20] Zhao EF, Cheng YP, Yu CX, et al. The systemic immune-inflammation index was non-linear associated with all-cause mortality in individuals with nonalcoholic fatty liver disease[J]. Ann Med, 2023, 55(1): 2197652. [21] Polk N, Budai B, Hitre E, et al. High neutrophil-to-lymphocyte ratio(NLR)and systemic immune-inflammation index(SII)are markers of longer survival after metastasectomy of patients with liver-only metastasis of rectal cancer[J]. Pathol Oncol Res, 2022, 28: 1610315. doi:10.3389/pore.2022.1610315. [22] Wang D, Hu X, Xiao L, et al. Prognostic nutritional index and systemic immune-inflammation index predict the prognosis of patients with HCC[J]. J Gastrointest Surg, 2021, 25(2): 421-427. [23] Jomrich G, Paireder M, Kristo I, et al. High systemic immune-inflammation index is an adverse prognostic factor for patients with gastroesophageal adenocarcinoma[J]. Ann Surg, 2021, 273(3): 532-541. [24] Liu JJ, Li S, Zhang S, et al. Systemic immune-inflammation index, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio can predict clinical outcomes in patients with metastatic non-small-cell lung cancer treated with nivolumab[J]. J Clin Lab Anal, 2019, 33(8): e22964. doi:10.1002/jcla.22964. [25] Anpalakhan S, Huddar P, Behrouzi R, et al. Immunotherapy-related adverse events in real-world patients with advanced non-small cell lung cancer on chemoimmunotherapy: a Spinnaker study sub-analysis[J]. Front Oncol, 2023, 13: 1163768. doi:10.3389/fonc.2023.1163768. |
[1] | 李博,刘竞芳,鲍金鹏,李祥泽,秦广洋,田虎. 三维可视化联合吲哚菁绿荧光影像技术在51例原发性肝癌腹腔镜切除术中的应用价值[J]. 山东大学学报 (医学版), 2022, 60(3): 83-88. |
[2] | 于金明,颜薇薇,陈大卫. 肺癌放射免疫新实践[J]. 山东大学学报 (医学版), 2021, 59(9): 1-8. |
[3] | 张继宗1,2,孟九大2,丁海2,易永祥2,余泽前3,周家华3. 血清天冬氨酸-天冬酰胺β羟化酶(ASPH)分子联合AFP和GP73检测对原发性肝癌的诊断意义[J]. 山东大学学报(医学版), 2014, 52(6): 78-80. |
[4] | 王旭,程宝泉,梁旭阳,贾俊英,李倩倩. 高迁移率族蛋白B1在肝癌细胞中的表达及其临床意义[J]. 山东大学学报(医学版), 2012, 50(4): 38-41. |
[5] | 徐晓梅1,于皎1, 李国华1,姜岩2,姜兆全3,张萍3,程晓云1. 益气补肾祛瘀法治疗肝功能失代偿的原发性肝癌的临床研究[J]. 山东大学学报(医学版), 2012, 50(12): 70-. |
[6] | 王晓花1,高淑春1,崔蕾2,蒋雪梅1,杜以真1. 白介素-28B在乙型肝炎病毒相关肝癌患者血清中的表达及意义[J]. 山东大学学报(医学版), 2012, 50(10): 106-110. |
[7] | 孔祥亘1,韩绍磊2,郑昭敏2,杜文军2,陈士俊2. 高尔基体蛋白73联合甲胎蛋白异质体在原发性肝癌诊断中的价值[J]. 山东大学学报(医学版), 2011, 49(4): 110-114. |
|