【摘要】 目的 探讨程序性死亡配体-1（PD-L1）阳性局部晚期或转移性非小细胞肺癌（NSCLC）患者的临床特征，分析其影响因素及预测指标诊断价值。方法 选取2017年1月—2023年12月于金华市中心医院行病理检查初次确诊为局部晚期或转移性NSCLC患者的临床资料。比较PD-L1阳性和阴性局部晚期或转移性NSCLC患者的临床资料，采用多因素Logistic回归分析对局部晚期或转移性NSCLC患者PD-L1阳性的影响因素进行分析，绘制受试者工作特征（ROC）曲线对其预测指标诊断价值进行分析。结果 本研究共纳入83例局部晚期或转移性NSCLC患者，其中43例（51.8%）患者PD-L1阳性。PD-L1阳性局部晚期或转移性NSCLC患者远处转移器官数量0～1个和低分化占比高于PD-L1阴性局部晚期或转移性NSCLC患者，差异有统计学意义（P<0.05）。正电子发射断层成像-计算机断层扫描（PET-CT）检查显示PD-L1阳性局部晚期或转移性NSCLC患者的最大标准化摄取值(SUV_max)高于PD-L1阴性局部晚期或转移性NSCLC患者，二者比较差异有统计学意义（P<0.05）。多因素Logistic回归分析结果显示，分化程度和远处转移器官数量是局部晚期或转移性NSCLC患者PD-L1阳性的影响因素（P<0.05）。PET-CT检查SUV_max对局部晚期或转移性NSCLC患者PD-L1阳性诊断价值的ROC曲线分析结果显示，曲线下面积为0.786，最佳截断值为9.95，敏感度为92.3%，特异度为77.8%。结论 局部晚期或转移性NSCLC患者PD-L1阳性与分化程度和远处转移器官数量密切相关，PET-CT检查SUV_max可在一定程度上诊断NSCLC患者PD-L1阳性。更多还原

【Abstract】 Objective To investigate the clinical characteristics of patients with positive programmed deathligand 1（PD-L1） locally advanced or metastatic non-small cell lung cancer（NSCLC）, and to analyze its influencing factors and diagnostic values of predictive indicators. Methods Clinical data of patients with locally advanced or metastatic NSCLC who were initially diagnosed by pathological examination in Jinhua Municipal Central Hospital from January 2017 to December 2023 were selected. Clinical data of patients with positive PD-L1 and negative locally advanced or metastatic NSCLC were compared. Multivariate logistic regression analysis was used to analyze the influencing factors of positive PD-L1 in patients with locally advanced or metastatic NSCLC. The receiver operating characteristic（ROC） curve was drawn to analyze the diagnostic values of its predictors. Results A total of 83 patients with locally advanced or metastatic NSCLC were included in this study, of which 43（51.8%） patients were positive PD-L1.The number of distant metastatic organs within 0-1 and the proportion of poorly differentiated in positive PD-L1 patients with locally advanced or metastatic NSCLC were higher than those in negative PD-L1 patients with locally advanced or metastatic NSCLC, and the differences were statistically significant（P < 0.05）. Positron emission tomography-computed tomography（PET-CT） examination showed that the maximum of standardized uptake value(SUV_max) of positive PD-L1 patients with locally advanced or metastatic NSCLC was higher than that of negative PD-L1 patients with locally advanced or metastatic NSCLC, and the difference was statistically significant（P < 0.05）. Multivariate Logistic regression analysis showed that the differentiated degree and the number of distant metastatic organs were the influencing factors of positive PD-L1 in patients with locally advanced or metastatic NSCLC（P < 0.05）. The ROC curve analysis of the diagnostic value of SUV_max by PET-CT examination for positive PD-L1 in patients with locally advanced or metastatic NSCLC showed that the area under the curve was 0.786, the optimal cutoff value was 9.95, the sensitivity was 92.3%, and the specificity was 77.8%. Conclusions Positive PD-L1 in patients with locally advanced or metastatic NSCLC is closely related to the differentiated degree and the number of distant metastatic organs. SUVmax by PET-CT examination may diagnose positive PD-L1 in NSCLC patients to a certain extent.更多还原