关键词: 甘油三酯-葡萄糖-体质量指数, 免疫检查点抑制剂, 恶性肿瘤, 免疫相关不良反应, 风险分层

Abstract:

Objective To explore the risk stratification value of the triglyceride-glucose-body mass index （TyG-BMI） for immune-related adverse reactions （irAE） in tumor patients treated with immune checkpoint inhibitors （ICIs）. Methods The clinical data of 204 hospitalized patients with malignant tumors who underwent programmed cell death protein 1/programmed cell death ligand 1 （PD-1/PD-L1） monoclonal antibody treatment at the Third Affiliated Hospital of Sun Yat-sen University from September 2023 to September 2024 were retrospectively collected. All patients were stratified into the TyG-BMI Q1 group， TyG-BMI Q2 group， TyG-BMI Q3 group， and TyG-BMI Q4 group based on the TyG-BMI quartiles， with 51 cases in each group. The clinical data and the incidence of immune-related adverse events （irAE） in the four groups were compared. Multivariate logistic regression analysis was performed to identify the influencing factors of irAE in cancer patients treated with immune checkpoint inhibitors （ICIs）. The receiver operating characteristic curve （ROC） was constructed to evaluate the predictive value of TyG-BMI for irAE. Pearson correlation analysis was carried out to examine the correlation between TyG-BMI levels and inflammatory factor levels， and the receiver operating characteristic curve （ROC） was plotted to assess the predictive value of TyG-BMI for irAE. Results Statistically significant differences were observed in body mass index （BMI）， dyslipidemia， history of diabetes， triglyceride， low-density lipoprotein （LDL-C）， fasting blood glucose， free thyroxine （FT4）， and Eastern Cooperative Oncology Group performance status score （ECOG score） among the four groups （P < 0.05）. Statistically significant differences were also noted in the incidence of any-grade irAE， grade ≥ 3 irAE， endocrine toxicity， and skin toxicity among the four groups （P < 0.05）. Univariate analysis indicated that a higher TyG-BMI was associated with a higher risk of any-grade irAE， grade ≥ 3 irAE， endocrine toxicity， pulmonary toxicity， skin toxicity， and other irAE （P < 0.05）. After adjusting for confounding factors such as age， gender， tumor type， drug category， and tumor stage， the results of multivariate logistic regression demonstrated that TyG-BMI was an independent risk factor for the occurrence of any- grade irAE （OR = 1.517， 95%CI： 1.220 ~ 1.886， P < 0.001）， grade ≥ 3 irAE （OR = 1.215， 95%CI： 1.046 ~ 1.410， P = 0.011）， and endocrine toxicity （OR = 1.331， 95%CI： 1.131 ~ 1.568， P < 0.001）. After further adjusting for white blood cell count （WBC）， hemoglobin （Hb）， platelet count （PLT）， alanine aminotransferase （ALT）， total bilirubin （TBIL）， serum creatinine （Scr）， troponin I （TnI）， and thyroid-stimulating hormone （TSH）， TyG-BMI remained an independent risk factor for the occurrence of any-grade irAE， grade ≥ 3 irAE， and endocrine toxicity （P < 0.05）. The levels of interleukin-6 （IL-6）， tumor necrosis factor-α （TNF-α）， and C-reactive protein （CRP） were compared among the four groups， and the differences were statistically significant （P < 0.05）. Pearson correlation analysis indicated that TyG-BMI was positively correlated with the levels of IL-6， TNF-α， and CRP （r = 0.643， 0.731， 0.894， P < 0.001）. The ROC curve demonstrated that the predictive value of TYG-BMI for any grade of irAE， grade ≥ 3 irAE， and endocrine irAE was higher than that of TyG and BMI （P < 0.05）. Conclusion TyG-BMI can be utilized to assess the risk of immune-related adverse events （irAE） in cancer patients undergoing treatment with immune checkpoint inhibitors （ICIs）， offering references for the formulation of clinical treatment plans and the evaluation of prognosis.

Key words: triglyceride-glucose-body mass index, immune checkpoint inhibitors, malignant tumors, immune-related adverse events, risk stratification