甘油三酯-葡萄糖指数对局晚期和晚期非小细胞肺癌免疫治疗疗效及预后的影响

The impact of triglyceride-glucose index on the efficacy of immunotherapy and prognosis of locally advanced and advanced non-small cell lung cancer

摘要

目的：研究胰岛素抵抗标志物甘油三酯-葡萄糖（triglyceride-glucose，TyG）指数是否可预测替雷利珠单抗联合化疗的局部晚期和晚期非小细胞肺癌（non-small cell lung cancer，NSCLC）患者的临床结局。方法：回顾性分析243例局晚期和晚期接受替雷利珠单抗联合化疗治疗的NSCLC患者的数据，根据使用X-tile软件确定的最佳截断值9.3，将患者分为高TyG指数组和低TyG指数组。Cox比例风险回归分析确定了影响总生存期（overall survival，OS）的独立预后因素，并基于这些因素建立列线图预测模型。结果：研究队列包括160例高TyG指数患者和83例低TyG指数患者。低TyG指数组的中位无进展生存期和DS显著长于高TyG指数组。低TyG指数组的客观缓解率为55.42%，而高TyG指数组为30.63%；相应的疾病控制率分别为95.18%和56.88%。多因素回归分析确定了治疗前最大肿瘤直径、程序性死亡配体1（programmed death ligand 1，PD-L1）阳性比例评分、体重指数（body mass index，BMI）和TyG指数作为DS的独立预后预测因子。列线图模型表明了TyG指数（HR=2.99，95%CI：1.73~5.16，P<0.001）作为主要预后预测因子的重要性，其次是PD-L1阳性比例评分、治疗前肿瘤最大直径和BMI。结论：TyG指数是局晚期和晚期NSCLC患者联合免疫治疗和化疗疗效的长期预测指标，低TyG指数预后较好。

Abstract

Objective：To investigate whether triglyceride - glucose（TyG）index，a marker of insulin resistance，can predict the clinical outcome of patients with locally advanced and advanced non - small cell lung cancer（NSCLC）treated with tislelizumab combined with chemotherapy. Methods：We retrospectively analyzed data from 243 patients who were treated with tislelizumab combined with chemotherapy with locally advanced and advanced NSCLC，dividing them into high and low TyG index groups based on an optimal cut - off value of 9.3，determined using the X - tile software. Cox proportional hazards regression analysis identified independent prognostic factors for overall survival（OS），and a prediction nomogram model was developed based on them. Results：The study cohort included 160 patients with a high TyG index and 83 with a low TyG index. The median progression-free survival and OS in the low TyG index group were significantly longer than in the high TyG index group. The objective response rate was 55.42% in the low TyG index group and 30.63% in the high TyG index group，while the respective disease control rates were 95.18% and 56.88% . Multifactorial regression analysis identified pre-treatment maximum tumour diameter，proportion score for programmed death ligand 1（PD - L1）positivity，body mass index（BMI），and TyG index as independent prognostic predictors of OS. The nomogram model emphasized the importance of the TyG index（hazard ratio：2.99，95% CI：1.73-5.16，P<0.001）as a major prognostic predictor，followed by the PD - L1 tumor proportion score，pre - treatment tumour diameter，and BMI. Conclusion：TyG index is a long - term predictor of the efficacy of combined immunotherapy and chemotherapy in patients with locally advanced and advanced NSCLC，and low TyG index has a better prognosis.

关键词

非小细胞肺癌 / 免疫治疗 / 预测模型 / 有效性 / 安全性

Key words

non-small cell lung cancer / immunotherapy / prediction model / efficacy / safety

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基金资助

南京医科大学部省共建肿瘤个体化医学协同创新中心-恒瑞医药临床研究基金面上项目(2024CICCPMHR020)