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中华肺部疾病杂志(电子版) ›› 2026, Vol. 19 ›› Issue (04) : 600 -606. doi: 10.3877/cma.j.issn.1674-6902.2026.04.011

论著

外周血炎症指数预测148例局部晚期NSCLC免疫化疗后MPR的临床意义
丁海斌1, 刘爽1, 乔丹1, 李新涛1, 陈艳妮2,(), 程蒿3, 刘佳3   
  1. 1710000 西安,陕西省肿瘤医院肿瘤内二科
    2725000 陕西,安康市中心医院肿瘤内科
    3710000 西安,陕西省肿瘤医院病理科
  • 收稿日期:2026-03-25 出版日期:2026-08-25
  • 通信作者: 陈艳妮
  • 基金资助:
    陕西省中医管理局中医药科研课题(LCPT037)

Clinical significance of peripheral blood inflammation index in predicting major pathological response after immunochemotherapy in 148 cases with locally advanced nonsmall cell lung cancer

Haibin Ding1, Shuang Liu1, Dan Qiao1, Xintao Li1, Yanni Chen2,(), Hao Cheng3, Jia Liu3   

  1. 1Department of Oncology Ⅱ, Shaanxi Cancer Hospital, Xi'an 710000, China
    2Department of Medical Oncology, Ankang Central Hospital, Ankang, 725000, China
    3Department of Pathology, Shaanxi Provincial Cancer Hospital, Xi′an 71000, China
  • Received:2026-03-25 Published:2026-08-25
  • Corresponding author: Yanni Chen
引用本文:

丁海斌, 刘爽, 乔丹, 李新涛, 陈艳妮, 程蒿, 刘佳. 外周血炎症指数预测148例局部晚期NSCLC免疫化疗后MPR的临床意义[J/OL]. 中华肺部疾病杂志(电子版), 2026, 19(04): 600-606.

Haibin Ding, Shuang Liu, Dan Qiao, Xintao Li, Yanni Chen, Hao Cheng, Jia Liu. Clinical significance of peripheral blood inflammation index in predicting major pathological response after immunochemotherapy in 148 cases with locally advanced nonsmall cell lung cancer[J/OL]. Chinese Journal of Lung Diseases(Electronic Edition), 2026, 19(04): 600-606.

目的

探讨外周血炎症指标对局部晚期非小细胞肺癌(nonsmall cell lung cancer, NSCLC)患者免疫联合化疗后主要病理缓解(major pathological response, MPR)的预测意义。

方法

选择2022年2月至2025年1月我院收治的接受新辅助免疫联合化疗局部晚期NSCLC患者104例,依据术后病理结果分为MPR为观察组63例与无MPR为对照组41例。收集患者临床资料、治疗前后中性粒细胞与淋巴细胞计数比值(neutrophiltolymphocyte ratio, NLR)、血小板与淋巴细胞计数比值(platelettolymphocyte ratio, PLR)、全身免疫炎症指数(systemic immuneinflammation, SII),预后营养指数(prognostic nutritional index, PNI),计算变化值(Δ=治疗后-治疗前)。采用LASSO回归筛选变量,多因素Logistic回归确定MPR影响因素并构建列线图;通过Kaplan-Meier法结合Log-Rank检验分析动态炎症评分与EFS的关联。

结果

观察组治疗后ΔNLR[-0.65(-1.71,-0.27)比0.58(0.22,1.94),Z=-5.053,P<0.001]、ΔPLR[-48.13(-102.80,-12.83)比26.22(-16.87,60.70),Z=-4.660,P<0.001]、ΔSII[-225.54(-411.09,-83.77)比380.83(104.52,538.33),Z=-5.768,P<0.001]低于对照组,ΔPNI[0.98(-1.80,3.71)比-1.63(-7.15,0.79),Z=-5.236,P<0.001]高于对照组。多因素Logistic回归显示,病理亚型(腺癌比鳞癌:OR=0.127,95%CI:0.021~0.769,P=0.025)、组织学分化(低分化比中分化:OR=0.022,95%CI:0.002~0.294,P=0.004)、ΔNLR(OR=0.518,95%CI:0.299~0.898,P=0.019)、ΔSII(OR=0.996,95%CI:0.993~0.998,P=0.002)、ΔPNI(OR=1.514,95%CI:1.146~2.001,P=0.004)为MPR影响因素。列线图模型预测MPR的AUC为0.95(95%CI:0.91~0.99),Hosmer-Lemeshow检验显示模型拟合良好(χ2=6.610,P=0.579),决策曲线显示0.10~0.92风险阈值区间内净临床获益高。以动态炎症评分中位值0.76为截点,低评分组(52例)中位EFS为22个月,短于高评分组52例36个月(Log-Rank χ2=30.989,P<0.001)。

结论

新辅助免疫联合化疗前后ΔNLR、ΔSII、ΔPNI是局部晚期NSCLC患者术后MPR的预测标志物;联合病理亚型、组织学分化程度构建列线图模型区分效能、校准度及临床净获益优异,可术前预测新辅助免疫联合化疗的病理应答,为患者远期复发风险分层提供参考。

Objective

To investigate the predictive value of peripheral blood inflammatory markers for major pathological response (MPR) in patients with locally advanced nonsmall cell lung cancer (NSCLC) receiving neoadjuvant immunochemotherapy.

Methods

A total of 104 patients with locally advanced NSCLC who received neoadjuvant immunochemotherapy at our hospital from February 2022 to January 2025 were retrospectively enrolled. Based on postoperative pathological findings, MPR were divided into the observation group (63 cases) and non MPR were the control group (41 cases). Clinical data, as well as pre and posttreatment neutrophiltolymphocyte ratio (NLR), platelettolymphocyte ratio (PLR), systemic immuneinflammation index (SII), and prognostic nutritional index (PNI), were collected. The change values (Δ=posttreatment-pretreatment) were calculated. LASSO regression was used for variable selection, and multivariate Logistic regression was performed to identify independent factors associated with MPR and to construct a nomogram. The association between dynamic inflammation score and eventfree survival (EFS) was analyzed using the KaplanMeier method with the Logrank test.

Results

After treatment, the observation group showed significantly lower ΔNLR[-0.65(-1.71, -0.27) vs. 0.58 (0.22, 1.94), Z= -5.053, P<0.001], ΔPLR[-48.13 (-102.80, -12.83) vs. 26.22 (-16.87, 60.70), Z=-4.660, P<0.001], and ΔSII[-225.54 (-411.09, -83.77) vs. 380.83 (104.52, 538.33), Z=-5.768, P<0.001], and significantly higher ΔPNI[0.98(-1.80, 3.71) vs. -1.63 (-7.15, 0.79), Z=-5.236, P<0.001] than the control group. Multivariate Logistic regression revealed that pathological subtype (adenocarcinoma vs. squamous cell carcinoma: OR=0.127, 95%CI: 0.021~0.769, P=0.025), histological differentiation (poorly differentiated vs. moderately differentiated: OR=0.022, 95%CI: 0.002~0.294, P=0.004), ΔNLR(OR=0.518, 95%CI: 0.299~0.898, P=0.019), ΔSII (OR=0.996, 95%CI: 0.993~0.998, P=0.002), and ΔPNI (OR=1.514, 95%CI: 1.146~2.001, P=0.004) were independent factors for MPR. The nomogram model yielded an AUC of 0.95 (95%CI: 0.91~0.99) for predicting MPR. The HosmerLemeshow test indicated good model calibration (χ2=6.610, P=0.579), and the decision curve analysis demonstrated a high net clinical benefit within the risk threshold range of 0.10~0.92. Using the median dynamic inflammation score of 0.76 as the cutoff, the lowscore group (52 cases) had a significantly shorter median EFS of 22 months compared with 36 months in the highscore group (52 cases) (Logrank χ2= 30.989, P<0.001).

Conclusions

Dynamic changes in ΔNLR, ΔSII, and ΔPNI before and after neoadjuvant immunochemotherapy are predictive biomarkers for postoperative MPR in patients with locally advanced NSCLC. The nomogram combining these markers with pathological subtype and histological differentiation exhibits excellent discriminative ability, calibration, and clinical net benefit, which may help preoperatively predict pathological response to neoadjuvant immunochemotherapy and provide a reference for longterm recurrence risk stratification.

表1 两组局部晚期NSCLC患者临床资料结果
表2 两组局部晚期NSCLC患者肿瘤分期及治疗
图1 局部晚期NSCLC患者影像学表现。图A为治疗前胸部CT肺窗轴位图像,可见右肺原发占位病灶基线形态及肺内周边结构;图B为新辅助免疫化疗后复查胸部CT肺窗轴位图像,对比可见原发病灶形态、大小变化,提示新辅助免疫化疗后肿瘤影像学应答改变;图C为治疗前胸部CT纵隔窗轴位图像,显示右肺原发病灶;图D为新辅助免疫化疗后复查胸部CT纵隔窗轴位,对比可见右肺原发病灶体积改变
图2 局部晚期NSCLC患者组织病理学图。图A为右中叶肺鳞状细胞癌Ⅱ~Ⅲ级;图B为肺腺癌Ⅱ~Ⅲ级伴局灶鳞状分化;图C为转移性低分化肺腺癌;图D为肺低分化鳞状细胞癌
表3 两组局部晚期NSCLC患者治疗前后炎症指数变化
表4 Logistic回归分析局部晚期NSCLC患者MPR的影响因素
图3 局部晚期NSCLC患者新辅助免疫化疗后MPR预测列线图
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