脾体积变化作为接受化疗-免疫治疗的广泛期小细胞肺癌的预后与免疫影像生物标志物

The spleen, the largest secondary lymphoid organ, plays an essential role in systemic immune regulation. Its function in tumor progression and treatment response has gained increasing attention.

This study aimed to evaluate the prognostic value of spleen volume (SV) change in patients with extensive-stage small-cell lung cancer (ES-SCLC) receiving first-line chemo-immunotherapy (CIT) and to explore its associations with tumor-infiltrating lymphocytes (TILs) and peripheral immune parameters. DESIGN: A single-center retrospective cohort study.

A total of 292 ES-SCLC patients who received first-line CIT were retrospectively analyzed. SV was measured on baseline and post-treatment CT scans, and the relative change was used to classify patients into increased or decreased SV groups. Cox proportional hazards regression models were used to assess the effects of SV metrics, immune-related indices, and clinicodemographic factors on overall survival (OS) and progression-free survival (PFS). Objective response rate (ORR) differences were tested using the chi-square test, and immune parameters were compared using Wilcoxon rank-sum tests and correlation analyses.

Multivariate analysis identified increased SV after CIT as an independent adverse prognostic factor for both OS (hazard ratio (HR) = 1.561, 95% confidence interval (CI), 1.193-2.041, p = 0.001) and PFS (HR = 1.411, 95% CI, 1.106-1.800, p = 0.006). Patients with increased SV exhibited significantly shorter OS and PFS and a lower ORR (all p < 0.005). Increased SV was also associated with markedly lower total, CD4+, and CD8+ TIL densities and, at the systemic level, lower absolute lymphocyte count (ALC), and higher neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) (all p < 0.0001), indicating both local and systemic immune suppression.

SV change reflects both local and systemic immune remodeling during CIT in ES-SCLC. As a noninvasive and measurable imaging biomarker, SV change holds translational potential for immune monitoring and treatment response assessment. Changes in spleen size may predict treatment outcomes in patients with advanced small-cell lung cancer receiving combined chemotherapy and immunotherapy The spleen is an important organ that helps regulate the immune system in the body. In people with cancer, changes in spleen size may reflect how the immune system responds to treatment. In this study, we investigated whether changes in spleen volume could predict treatment outcomes in patients with extensive-stage small-cell lung cancer (ES-SCLC) receiving first-line chemotherapy combined with immunotherapy. We reviewed the medical records and CT scans of 292 patients treated at our hospital. Spleen volume was measured on CT scans before treatment and after treatment. Patients were divided into two groups: those whose spleen volume increased and those whose spleen volume decreased. We then analyzed the relationships between spleen volume change, treatment response, survival, and immune-related indicators measured in blood and tumor tissue. We found that patients whose spleen volume increased after treatment had shorter survival and poorer treatment responses. These patients also showed signs of weaker anti-tumor immunity, including fewer immune cells within tumors and lower lymphocyte levels in the blood, along with higher levels of inflammation-related markers. These results suggest that changes in spleen size may provide a simple sign of how the immune system is functioning during treatment. Measuring spleen volume on routine CT scans could help clinicians monitor immune status and estimate treatment effectiveness in patients with ES-SCLC.