Background/Objectives:Immune checkpoint inhibitors targeting the PD-1/PD-L1 axis have become a standard in the treatment of all stages of non-small lung cancer. Beyond tumor-intrinsic biomarkers like PD-L1 expression, evidence points to the role of patient-related factors, such as body mass index, sarcopenia, and cachexia. These body composition parameters may reflect metabolic reserve or even immune competence and could help stratify outcomes in patients treated with PD-1 and PD-L1. This systematic review aims to evaluate the impact of body composition—specifically BMI, pretreatment weight loss, sarcopenia, and cachexia—on clinical outcomes such as progression-free and overall survival in NSCLC patients treated with immune checkpoint inhibitors.Methods:A systematic literature search was conducted across multiple databases including PubMed, Google Scholar, and Science Direct. We included full-text original research articles (1 January 2020–1 May 2025) reporting clinical outcomes of NSCLC patients treated with PD-1 or PD-L1 inhibitors, in relation to body composition factors (BMI, pretreatment weight loss, sarcopenia, cachexia). Eligible studies involved adults (>18 years) and included observational cohorts or controlled trials; animal or in vitro studies were excluded. Data extraction and risk of bias assessments were performed independently by two reviewers, with discrepancies being resolved through a third one.Results:From 12,358 records identified, 21 studies met the inclusion criteria. Most were retrospective cohorts assessing the impact of pre-treatment weight loss, cachexia, and sarcopenia on ICI outcomes in NSCLC. These factors consistently predicted poorer survival and response, while BMI alone showed limited prognostic value. Considerable heterogeneity in body composition definitions and outcome reporting was observed.Conclusions:Body composition—particularly weight loss, cachexia, and sarcopenia—significantly impacts survival and response in NSCLC patients treated with ICIs. These factors reflect immune–metabolic dysfunction that may impair treatment efficacy. BMI alone is insufficient; routine assessment of muscle mass and cachexia could improve risk stratification.
**背景/目的：** 靶向PD-1/PD-L1轴的免疫检查点抑制剂已成为治疗各期非小细胞肺癌的标准方案。除PD-L1表达等肿瘤内在生物标志物外，证据表明患者相关因素（如体重指数、肌肉减少症和恶病质）也发挥重要作用。这些身体成分参数可能反映患者的代谢储备甚至免疫功能状态，有助于在接受PD-1/PD-L1抑制剂治疗的患者中进行预后分层。本系统综述旨在评估身体成分（特别是BMI、治疗前体重减轻、肌肉减少症和恶病质）对接受免疫检查点抑制剂治疗的非小细胞肺癌患者无进展生存期和总生存期等临床结局的影响。 **方法：** 在PubMed、Google Scholar和Science Direct等多个数据库中进行系统性文献检索。纳入标准为2020年1月1日至2025年5月1日期间发表、报告非小细胞肺癌患者接受PD-1或PD-L1抑制剂治疗临床结局与身体成分因素（BMI、治疗前体重减轻、肌肉减少症、恶病质）相关性的全文原创研究。研究需涉及成人（>18岁），包括观察性队列或对照试验；排除动物或体外研究。数据提取和偏倚风险评估由两名评审员独立完成，分歧通过第三位评审员协商解决。 **结果：** 从12,358条记录中筛选出21项符合纳入标准的研究。多数为回顾性队列研究，评估治疗前体重减轻、恶病质和肌肉减少症对非小细胞肺癌患者免疫检查点抑制剂疗效的影响。这些因素一致提示较差的生存率和治疗反应，而单独使用BMI的预后价值有限。研究观察到身体成分定义和结局报告存在显著异质性。 **结论：** 身体成分（尤其是体重减轻、恶病质和肌肉减少症）显著影响接受免疫检查点抑制剂治疗的非小细胞肺癌患者的生存率和治疗反应。这些因素反映了可能损害治疗效果的免疫代谢功能障碍。仅依靠BMI评估不足；常规评估肌肉质量和恶病质状态可改善风险分层。
肿瘤(癌症)患者之家