iSEND免疫评分及LIPI对免疫联合化疗治疗广泛期小细胞肺癌疗效的预测价值

卢刚; 刘黎明; 吕允相

doi:10.16766/j.cnki.issn.1674-4152.004440

iSEND免疫评分及LIPI对免疫联合化疗治疗广泛期小细胞肺癌疗效的预测价值

doi: 10.16766/j.cnki.issn.1674-4152.004440

蚌埠医科大学第一附属医院呼吸与危重症医学科，安徽蚌埠 233004

基金项目:

安徽省高校自然科学基金重点项目 KJ2021A0750

详细信息

通讯作者:
刘黎明，E-mail: bbmcllm@126.com

中图分类号: R734.2 R730.5
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出版历程
- 收稿日期: 2025-03-13

Predictive value of iSEND immunity scoring system and LIPI on the efficacy of immuno-combination chemotherapy for extensive stage small cell lung cancer treatment

Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui 233004, China

摘要

摘要: 目的分析iSEND免疫评分与肺免疫预后指数(LIPI)在广泛期小细胞肺癌患者免疫联合化疗治疗疗效及预后中的预测价值，以探索可指导临床治疗的新指标。方法回顾性分析2022年6月—2024年12月蚌埠医科大学第一附属医院收治的127例应用免疫联合化疗治疗的广泛期小细胞肺癌患者的临床资料，分别利用iSEND免疫评分及LIPI对患者进行分组，构建ROC曲线比较2种评分对疗效及预后的预测效能。利用Kaplan-Meier法、单因素和多因素Cox回归分析研究各种预后相关因素和PFS间的关系。结果 iSEND免疫评分不良组、中等组、良好组中位无进展生存期(PFS)分别为3.50、8.50、13.17个月；LIPI不良组、中等组、良好组中位PFS分别为3.67、8.20和10.83个月，差异均有统计学意义(P＜0.001)。LIPI预测疾病控制率(DCR)、客观缓解率(ORR)、PFS的AUC分别为0.731、0.725、0.751，iSEND免疫评分预测DCR、ORR、PFS的AUC分别为0.708、0.649、0.677，均小于LIPI(P＜0.01)。Cox回归分析显示，LDH和dNLR在全组和各亚组中都是PFS的独立预测因素。结论 2种评分在免疫联合化疗治疗ES-SCLC患者疗效及预后中均具有良好的预测价值，且LIPI预测能力更强。LDH和dNLR作为LIPI的评分因素在全组和各亚组中均是PFS的独立预测因素，这可能与LIPI预测能力强于iSEND免疫评分有关。
- 广泛期小细胞肺癌 /
- iSEND免疫评分 /
- 肺免疫预后指数 /
- 免疫联合化疗 /
- 预后
Abstract: Objective To analyze the predictive value of iSEND immune score and lung immune prognostic index (LIPI) in the prognosis and efficacy of immunotherapy combined with chemotherapy in patients with extensive-stage small cell lung cancer, and to explore novel indicators guided clinical treatment. Methods A retrospective analysis was performed on the clinical data of 127 patients with extensive-stage small cell lung cancer (ES-SCLC) treated with immunotherapy combined with chemotherapy (CIT) admitted to the First Affiliated Hospital of Bengbu Medical University from June 2022 to December 2024. Patients were stratified according to the iSEND immune score and LIPI, respectively, and receiver operating characteristic (ROC) curves were constructed to compare the predictive efficacy of the two scoring systems for treatment response and prognosis. Kaplan-Meier method, univariate and multivariate Cox regression analyses were applied to explore the association between various prognosis-related factors and progression-free survival (PFS). Results The median PFS was 3.50 months, 8.50 months, and 13.17 months in the poor, intermediate, and favorable subgroups of the iSEND immune score, respectively; while the median PFS was 3.67 months, 8.20 months, and 10.83 months in the corresponding subgroups of the LIPI, with statistically significant differences (P < 0.001). The area under the curve (AUC) values of LIPI for predicting disease control rate (DCR), objective response rate (ORR), and PFS were 0.731, 0.725, and 0.751, respectively, whereas those of the iSEND immune score were 0.708, 0.649, and 0.677, which were significantly lower than those of LIPI (P < 0.01). Cox regression analysis revealed that lactate dehydrogenase (LDH) and derived neutrophil-to-lymphocyte ratio (dNLR) were independent prognostic factors for PFS in both the entire cohort and all subgroups. Conclusion Both scoring systems exhibit favorable predictive value for the prognosis and efficacy of CIT in patients with ES-SCLC, with LIPI demonstrating superior predictive ability. LDH and dNLR, as LIPI components, are independent predictors of PFS across overall and subgroup analyses, likely attributed to LIPI's enhanced predictive capacity over the iSEND model.
- Extensive stage small cell lung cancer /
- iSEND immune score /
- Lung immune prognostic index /
- Immunotherapy combined with chemotherapy /
- Prognosis
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图 1 LIPI各组在全组及PD-1/PD-L1抑制剂联合化疗治疗亚组患者的生存曲线

注: A为全组(PD1+PD-L1)患者根据LIPI进行分组后各组的KM生存曲线; B为应用PD-1抑制剂治疗的患者根据LIPI进行分组后各组的KM生存曲线; C为应用PD-L1抑制剂治疗的患者根据LIPI进行分组后各组的KM生存曲线。

Figure 1. Survival curves of LIPI subgroups in the overall cohort and the PD-1/PD-L1 inhibitor combined with chemotherapy subgroup

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图 2 iSEND免疫评分各组在全组及PD-1/PD-L1抑制剂联合化疗治疗亚组患者的生存曲线

注: A为全组(PD1+PD-L1)患者根据iSEND进行分组后各组的KM生存曲线; B为应用PD-1抑制剂治疗的患者根据iSEND进行分组后各组的 KM生存曲线; C为应用PD-L1抑制剂治疗的患者根据iSEND进行分组后各组的KM生存曲线。

Figure 2. Survival curves of iSEND immune score subgroups in the overall cohort and the PD-1/PD-L1 inhibitor combined with chemotherapy subgroup

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图 3 LIPI、iSEND免疫评分预测DCR、ORR、PFS的ROC曲线

注：A为LIPI和iSEND对DCR预测的ROC曲线；B为LIPI和iSEND对ORR预测的ROC曲线；C为LIPI和iSEND对PFS预测的ROC曲线。

Figure 3. ROC curves of LIPI and iSEND immune scores for predicting DCR, ORR, and PFS

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表 1 127例ES-SCLC患者临床特征

Table 1. Clinical characteristics of 127 patients with ES-SCLC

项目	例数	占比(%)
性别
男性	98	77.2
女性	19	22.8
年龄
＜65岁	69	54.3
≥65岁	58	45.7
吸烟史
有	31	24.4
无	96	75.6
ECOG PS
＜2分	113	89.0
≥2分	14	11.0
NLR
＜5	105	82.7
≥5	22	17.3
DNLR
＜0	81	63.8
≥0	46	36.2
dNLR
≤1.99	67	52.8
＞1.99	60	47.2
LDH
≤250 IU/L	73	57.5
＞250 IU/L	54	42.5
ICIs
PD-1	75	59.1
PD-L1	52	40.9
预后
CR	3	2.4
PR	55	43.3
SD	42	33.1
PD	27	21.2
iSEND
良好组	20	15.7
中等组	89	70.1
不良组	18	14.2
LIPI
良好组	35	27.6
中等组	70	55.1
不良组	22	17.3
注：ICIs为免疫检查点抑制剂(immune checkpoint inhibitors)。

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表 2 全组与PD-1/PD-L1抑制剂联合化疗治疗亚组患者PFS单因素与多因素Cox回归分析

Table 2. Univariate and multivariate Cox regression analyses of PFS in the overall cohort and the PD-1/PD-L1 inhibitor combined with chemotherapy subgroup

变量	全组患者		PD-1抑制剂联合化疗		PD-L1抑制剂联合化疗
变量	单因素	多因素	单因素	多因素	单因素	多因素
性别
HR(95% CI)	1.454(0.868~2.438)		1.537(0.722~3.274)		1.259(0.607~2.610)
P值	0.155		0.265		0.537
年龄
HR(95% CI)	1.135(0.748~1.721)		1.052(0.609~1.816)		1.232(0.633~2.397)
P值	0.552		0.857		0.539
PS评分
HR(95% CI)	5.744(2.849~11.580)	1.771(0.842~3.726)	4.365(1.746~10.912)	1.633(0.621~4.297)	8.736(2.808~27.185)	2.369(0.710~7.903)
P值	＜0.001	0.132	0.002	0.320	＜0.001	0.161
吸烟史
HR(95% CI)	1.531(0.696~1.748)		1.531(0.842~2.783)		0.832(0.398~1.742)
P值	0.677		0.162		0.626
LDH
HR(95% CI)	4.392(2.765~6.976)	5.148(2.992~8.860)	4.058(2.206~7.466)	4.564(2.343~8.887)	5.459(2.590~11.505)	5.565(2.056~15.059)
P值	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	0.001
dNLR
HR(95% CI)	2.392(1.568~3.717)	2.965(1.817~4.838)	2.392(1.384~4.135)	2.841(1.596~5.056)	2.383(1.185~4.791)	3.219(1.310~7.909)
P值	＜0.001	＜0.001	0.002	＜0.001	0.015	0.011
NLR
HR(95% CI)	2.235(1.296~3.855)	0.977(0.543~1.757)	0.002(0.566~3.135)		4.572(2.050~10.198)	1.482(0.543~4.047)
P值	0.004	0.938	0.511		＜0.001	0.443
DNLR
HR(95% CI)	1.491(0.985~2.256)		1.060(0.619~1.817)		1.996(1.021~3.903)	2.382(1.131~5.013)
P值	0.059		0.831		0.043	0.022
注：性别，男性=1，女性=0；年龄＜65岁=1，≥65岁=0；PS评分＜2分=1，≥2分=0；吸烟史，是=1，否=0；LDH≤250 IU/L=1, 250 IU/L=0；dNLR≤1.99=1, ＞1.99=0；NLR＜5=1, ≥5=0；DNLR＜0=1, ≥0=0。

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