Several factors have been associated with the occurrence of immune-related adverse events (irAEs) induced by immune checkpoint inhibitor (ICI) therapy. Despite their availability, the predictive value of circulating blood cell parameters remains underexplored. Our aim was to investigate whether baseline values of and early changes in absolute neutrophil count (ANC), absolute lymphocyte count (ALC), other blood cell counts, and lymphocyte-related ratios can predict irAEs and whether sex may differentially influence this potential predictive ability. Of the 145 patients included, 52 patients (35.8%) experienced at least one irAE, with a 1-year cumulative incidence of 41.6%. Using Fine and Gray competing risk models, we identified female sex (hazard ratio (HR) = 2.17, 95% confidence interval (CI) = 1.20–3.85), high ALC before ICI initiation (HR = 1.63, 95% CI = 1.09–2.45), and low ANC after ICI initiation (HR = 0.81, 95% CI = 0.69–0.96) as predictors of irAEs. However, ALC and ANC may only have an impact on the risk of irAEs in women (stratified for female sex, ALC-related HR = 2.61, 95% CI = 1.40–4.86 and ANC-related HR = 0.57, 95% CI = 0.41–0.81). Priority should be given to developing models to predict ICI-related toxicity and their validation in various settings, and such models should assess the impact of patient sex on the risk of toxicity.
多种因素与免疫检查点抑制剂治疗引发的免疫相关不良事件发生相关。尽管循环血细胞参数易于获取，但其预测价值尚未得到充分探索。本研究旨在探讨中性粒细胞绝对计数、淋巴细胞绝对计数、其他血细胞计数及淋巴细胞相关比值的基线水平与早期变化能否预测免疫相关不良事件，并分析性别差异是否影响这种预测能力。在纳入的145例患者中，52例（35.8%）至少发生一种免疫相关不良事件，1年累积发生率为41.6%。通过Fine-Gray竞争风险模型分析，我们发现女性（风险比=2.17，95%置信区间=1.20-3.85）、治疗前高淋巴细胞绝对计数（风险比=1.63，95%置信区间=1.09-2.45）以及治疗后低中性粒细胞绝对计数（风险比=0.81，95%置信区间=0.69-0.96）是免疫相关不良事件的预测因素。然而，淋巴细胞绝对计数与中性粒细胞绝对计数可能仅对女性患者的免疫相关不良事件风险产生影响（女性分层分析显示：淋巴细胞相关风险比=2.61，95%置信区间=1.40-4.86；中性粒细胞相关风险比=0.57，95%置信区间=0.41-0.81）。未来应优先开发预测免疫检查点抑制剂相关毒性的模型并在不同临床环境中进行验证，此类模型需评估患者性别对毒性风险的影响。
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