[摘 要] 目的：探索预后营养指数（PNI）在接受诱导化疗联合免疫（化免）序贯放疗的局部晚期食管鳞状细胞癌（ESCC）中的 疗效预测价值及预后影响。方法: 回顾性分析浙江省肿瘤医院2019年5月至2023年8月期间收治的126例行诱导化免序贯放疗 的局部晚期ESCC患者的临床资料。绘制受试者工作特征曲线（ROC曲线），确定患者诱导化免前1周内、放疗前1周内、放疗开 始后4 ± 1周的PNI最佳临界值并对患者进行分组。采用Kaplan-Meier法绘制生存曲线，并用Log-Rank法比较组间患者的总生 存期（OS）及无进展生存期（PFS），采用Cox回归分析探讨诱导化免序贯放疗的局部晚期ESCC患者的预后影响因素。结果: 共 纳入126例局部晚期ESCC患者，男性118例，女性8例，中位年龄65岁（44~78岁）。运用ROC曲线确认的患者诱导化免前、放疗 前和放疗中PNI最佳临界值为46.2、48.3和37.9。放疗前PNI ≥ 48.3组中位OS、PFS分别为47.3、28.2个月，放疗前PNI < 48.3组 中位OS、PFS分别为18.7、15.2个月（P < 0.01，P < 0.05）。放疗中PNI ≥ 37.9组中位OS未达到，中位PFS为25.7个月，放疗中 PNI < 37.9组中位OS、PFS分别为17.0、12.5个月（P < 0.01，P < 0.05）。诱导化免后PNI升高组中位OS未达到，中位PFS为28.4个 月；PNI降低组中位OS、PFS分别为20.4、16.0个月（P < 0.01，P < 0.05）。多因素分析显示，放疗中PNI[HR = 2.292，95% CI（1.264, 4.159），P < 0.05]、诱导化免后PNI变化[HR = 2.120, 95% CI（1.007, 4.463），P < 0.05]为影响OS因素。结论: 放疗中PNI、诱导化 免后PNI变化与患者治疗疗效及预后有一定相关性，可作为预测ESCC化免序贯放疗获益的重要指标。

[Abstract] Objective: To explore the predictive and prognostic value of prognostic nutritional index (PNI) for patients with locally advanced esophageal squamous cell carcinoma (ESCC) undergoing induction chemotherapy combined with immune sequential radiotherapy. Methods: A retrospective analysis was conducted on clinical data from 126 locally advanced ESCC patients who had undergone induction chemotherapy combined with immune sequential radiotherapy at Zhejiang Cancer Hospital between May 2019 and August 2023. Receiver operating characteristic (ROC) curves were used to determine optimal PNI cutoff values within 1 week before induction chemoimmunotherapy, within 1 week before radiotherapy, and at 4 ± 1 weeks after radiotherapy initiation, with subsequent patient stratification. The Kaplan-Meier method was used to generate survival curves and the log-rank test was used to compare overall survival (OS) and progression-free survival (PFS) between groups. Cox regression analysis was employed to identify factors affecting the prognosis of locally advanced ESCC patients undergoing induction chemoimmunotherapy combined with sequential radiotherapy. Results: A total of 126 locally advanced ESCC patients, 118 males and 8 females, with a median age of 65 years (44-78 years) were included. The optimal critical values of PNI before induction chemoimmunotherapy, before radiotherapy and during radiotherapy identified using ROC curves were 46.2, 48.3 and 37.9. The median OS and PFS were 47.3 and 28.2 months in the group with PNI ≥ 48.3 before radiotherapy, and 18.7 and 15.2 months in the group with PNI < 48.3 before radiotherapy, respectively (P < 0.01, P < 0.05). The median OS was not reached and the median PFS was 25.7 months in the group with PNI ≥ 37.9 in radiotherapy, and the median OS and PFS were 17.0 and 12.5 months in the group with PNI < 37.9 in radiotherapy, respectively (P < 0.01, P < 0.05). The median OS was not reached and the median PFS was 28.4 months in the group with elevated PNI after induction chemoimmunization; the median OS and PFS were 20.4 and 16.0 months in the group with reduced PNI (P < 0.01, P < 0.05). Multifactorial analysis showed that PNI in radiotherapy [HR = 2.292, 95% CI (1.264, 4.159), P < 0.05], and change in PNI after induction of chemoimmunization [HR = 2.120, 95% CI (1.007, 4.463), P < 0.05] were factors affecting OS. Conclusion: PNI during radiotherapy and changes in PNI after induction chemoimmunity correlate with patients' treatment efficacy and prognosis, and can be used as important indicators to predict the benefits of induction chemoimmunization combined with sequential radiotherapy for ESCC.

浙江省医药卫生科技项目（No. 2022481960）；浙江省基础公益项目（No. LGF21H160005）; 浙江省医药卫生科技计 划项目（No. 2024KY049）；浙江省中医药科技计划项目（No. 2023ZL288）