分析放疗联合免疫治疗局部晚期非小细胞肺癌(nonsmall-cell lung cancer, NSCLC)患者治疗相关性的肺炎(treatment-related pneumonia, TRP)的发生率及其和系统免疫炎症指数(systemic immune-inflammation index, SII)的相关性。

回顾性分析于2021年1月至2024年12月我院收治局部晚期不可手术NSCLC患者89例为研究对象。根据治疗方案，分为联合组(放疗＋免疫)和放疗组(单纯放疗)，比较两组TRP的发生率和严重度；次要研究指标为探索联合组中治疗前SII与TRP的相关性。

联合组发生TRP 27例(61.36%)高于放疗组16例(35.56%)(P<0.05)；联合组≥3级TRP发生7例(15.91%)高于放疗组2例(4.44%)(P>0.05)。联合组27例TRP患者中，发生磨玻璃影23例(85.18%)、实变影15例(55.56%)、网格影10例(37.04%)、双肺受累10例(37.04%)；放疗组16例TRP患者中，发生磨玻璃影12例(75.00%)、实变影7例(43.75%)、网格影5例(31.25%)、双肺受累4例(25.00%)。联合组发生率高于放疗组(P>0.05)。联合组中发生TRP患者的治疗前SII值[1 035.1 (568.8，1 727.5)]高于未发生TRP者[472.0 (336.4，851.3)] (χ²＝7.35，P＝0.01)。多因素Logistic回归分析显示，联合组中治疗前SII升高是发生TRP的危险因素(OR＝1.01，95%CI：1.01~1.01，P<0.05)，在不同调整模型中验证了结果的稳健性。

放疗联合免疫治疗较单纯放疗增加了TRP的发生风险，临床治疗中需要谨慎选择联合方案。治疗前SII的升高可能与TRP的发生相关，提示SII可能成为潜在生物标志物。

The present study explores the incidence of treatment-related pneumonitis (TRP) in patients with locally advanced non-small cell lung cancer (NSCLC) undergoing radiotherapy combined with immunotherapy, and its association with systemic immune-inflammation index (SII).

A retrospective analysis of the clinical data of patients with unresectable locally advanced NSCLC patients who were treated at the hospital from January 2021 to December 2024 was conducted. The patients were divided into two groups according to whether they received immunotherapy: a combined group (radiotherapy + immunotherapy) and a radiotherapy group (radiotherapy only). The primary research objective was to make a comparison between the incidence and severity of TRP in the two groups, and the secondary research objective was to explore the relationship between pre-treatment SII and TRP in the combined group.

The study population comprised 89 patients, predominantly male 82 patients(92.13%), with 41 patients (46.07%) aged ≥65 years. The incidence of TRP in the combination group was 27 cases (61.36%), which was higher than that in the radiotherapy group 16 cases (35.56%)(P<0.05). The incidence of grade ≥3 TRP in the combination group was 7 cases (15.91%), higher than the radiotherapy group 2 cases(4.44%)(P>0.05). In the combined group, among the 27 patients with TRP, ground-glass opacities occurred in 23 cases (85.18%), consolidation in 15 cases (55.56%), reticular opacities in 10 cases (37.04%), and bilateral lung involvement in 10 cases (37.04%). In the radiotherapy group, among the 16 patients with TRP, ground-glass opacities occurred in 12 cases (75.00%), consolidation in 7 cases (43.75%), reticular opacities in 5 cases (31.25%), and bilateral lung involvement in 4 cases (25.00%). The incidence rates in the combination group were higher than those in the radiotherapy group, but the differences were not statistically significant (P>0.05). Higher pre-treatment SII values[1 035.1 (568.8, 1 727.5)] than those without TRP[472.0(336.4, 851.3)] (χ²=7.35, P=0.01). Multivariate logistic regression analysis confirmed that elevated SII was an independent risk factor for TRP in the combination group(OR=1.01, 95%CI: 1.01~1.01, P<0.05), with consistent results across different adjustment models.

In comparison with radiotherapy administered in isolation, the combination of radiotherapy and immunotherapy has been observed to result in an elevated probability of TRP. Consequently, it is imperative that caution is exercised when formulating combined treatment plans in clinical practice. The increase in SII prior to treatment may be associated with the occurrence of TRP, suggesting that SII may serve as a potential biomarker.