目的 探讨血清钾、钠、氯离子浓度对接受免疫检查点抑制剂(ICI)治疗的非小细胞肺癌(NSCLC)患者疗效影响.方法 回顾性分析2017-06-01-2023-06-01在北京航天总医院行ICI单药或联合治疗的149例Ⅲ期或Ⅳ期NSCLC患者临床资料,根据疗效分为客观缓解[完全缓解(CR)+部分缓解(PR)]组(51例)和非客观缓解[疾病稳定(SD)+疾病进展(PD)]组(98例)以及疾病控制(CR+PR+SD)组(105例)和PD组(44例),采用独立样本t检验比较组间治疗前后血清钾、钠、氯离子差异.Cox单因素和多因素比例风险回归模型分析无进展生存期(PFS)和总生存期(OS)相关因素.结果 CR+PR组和SD+PD组,组间各离子指标差异无统计学意义.与PD组相比,CR+PR+SD组pre-Na+(141.8±4.4 vs 139.9±5.6;t=2.289,P=0.024)、post-Na+(141.0±4.6 vs 139.0±5.5;t=2.152,P=0.035)、post-Cl-(103.2±3.1 vs 101.6±4.4;t=2.285,P=0.026)和 post-Na++Cl-(244.3±6.7 vs 240.6±9.3;t=2.706,P=0.008)较高.Cox 单因素回归分析结果显示,pre-Na+＜137 mmol/L[HR(95％CI)为 1.591(1.027～2.464),P=0.038]和pre-Cl-＜101 mmol/L[HR(95％CI)为 1.571(1.056～2.336),P=0.026]是较短 PFS 的危险因素;pre-Na+＜137 mmol/L[HR(95％CI)为 1.971(1.170～3.321),P=0.011]、(pre-Na++Cl-)＜241 mmol/L[HR(95％CI)为 1.703(1.070～2.713),P=0.025]和 post-Na+＜137 mmol/L[HR(95％CI)为 1.687(1.061～2.684),P=0.027]是较短 OS 的危险因素.Cox 多因素回归分析结果提示post-Na+＜137 mmol/L[HR(95％CI)为1.632(1.010～2.639),P=0.046]是较短OS的独立危险因素.结论 接受ICI治疗的NSCLC患者中较高血清钠离子和氯离子浓度预示着较好的预后结果.
The influence of serum ions on the efficacy of immune checkpoint inhibitor in the treatment of non-small cell lung cancer
Objective To investigate the effects of serum potassium,sodium and chloride ion concentrations on the efficacy of immune checkpoint inhibitors(ICIs)in patients with non-small cell lung cancer(NSCLC).Methods The clinical data of 149 patients with stage Ⅲ or Ⅳ NSCLC who received ICI monotherapy or combination therapy from June 1,2017,to June 1,2023 in Beijing Aerospace General Hospital were retrospectively analyzed.They were divided into objective response[complete response(CR)+partial response(PR)]group(n=51),non-objective response[stable disease(SD)+pro-gressive disease(PD)]group(n=98),disease control(CR+PR+SD)group(n=105),and PD group(n=44)based on efficacy.Independent sample t-test was used to compare the differences between groups in serum potassium,sodium,chlo-ride concentration before and after treatment.Factors related to progression-free survival(PFS)and overall survival(OS)were analyzed using Cox univariate and multifactorial proportional risk regression models.Results There was no signifi-cant difference in ion indexes between CR+PR group and SD+PD group.Compared with PD group,CR+PR+SD group had higher pre-Na+(141.8±4.4 vs 139.9±5.6;t=2.289,P=0.024),post-Na+(141.0±4.6 vs 139.0±5.5;t=2.152,P=0.035),post-Cl-(103.2±3.1 vs 101.6±4.4;t=2.285,P=0.026)and post-Na++Cl-(244.3±6.7 vs 240.6±9.3;t=2.706,P=0.008).Cox univariate regression analysis showed that pre-Na+＜137 mmol/L[HR(95％CI)1.591(1.027-2.464),P=0.038]and pre-Cl-＜101 mmol/L[HR(95％CI)1.571(1.056-2.336),P=0.026]were risk factors for short PFS,and pre-Na+＜137 mmol/L[HR(95％CI)1.971(1.170-3.321),P=0.011],pre-Na++Cl-＜241 mmol/L[HR(95％CI)1.703(1.070-2.713),P=0.025],post-Na+＜137 mmol/L[HR(95％CI)1.687(1.061-2.684),P=0.027]were risk factors for shorter OS.Cox multivariate regression analysis indicated that post-Na+＜137 mmol/L[HR(95％CI)1.632(1.010-2.639),P=0.046]was an independent risk factor for shorter OS.Conclusion Higher serum concentrations of sodium and chloride in NSCLC patients treated with immune checkpoint inhibitors are in-dicative of a better prognosis.
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