只有少数ES-SCLC患者在维持免疫治疗（IT）中体验到了长期生存益处。脂肪激素诱导的代谢性元炎与肥胖患者对IT的反应性增强有关；然而，它们在SCLC中的预后角色目前存在争议。利用术前CT扫描确定腹部脂肪分布，并在空腹时采集血样以测定血糖、胰岛素、胃泌素、瘦素和脂肪激素（TNF-α、IFN-γ、IL-6和MCP-1）。具有已知2型糖尿病史或HOMA指数大于2.5的代谢综合征患者被视为胰岛素抵抗（IR）。在接受维持IT的ES-SCLC患者中，瘦素浓度增加和瘦素/内脏脂肪组织（VAT）比值升高与缓解PFS密切相关。通过应用分层聚类算法，我们确定了一个具有较高瘦素值和较低炎症因子（TNF-α、IFN-γ和IL-6）的患者群，他们的PFS更长（13.2 vs 8.05个月；HR：0.42 [0.18-0.93] p = 0.02），且OS也更长（18.04 vs 12.09个月；HR：0.53 [0.25-1.29] p = 0.07）。脂肪激素在决定抗癌免疫疗法的效果中可以起到重要作用。代谢性免疫功能紊乱的角色需要进一步的临床前验证，并目前正在进行更大规模的前瞻性队列研究中调查。© 2023. 作者。

Only few ES-SCLC patients experience long-term survival benefit by maintenance IT. Adipokines-induced metabolic meta-inflammation has been related to enhanced responsiveness to IT in obese patients; however, their prognostic role in SCLC is currently controversial.Pre-treatment CT scan was used for determining distribution of abdominal adiposity, and blood samples were collected at fasting for measuring glycemia, insulin, ghrelin, leptin and adipokines (TNF-α, IFN-γ, IL-6 and MCP-1). Patients with known history of DM type II or metabolic syndrome with HOMA index > 2.5 were considered insulin resistant (IR).In ES-SCLC pts receiving maintenance IT, increased leptin concentration and higher leptin/visceral adipose tissue (VAT) ratio were significantly associated with prolonged PFS. By applying a hierarchical clustering algorithm, we identified a cluster of patients characterized by higher leptin values and lower pro-inflammatory cytokines (TNF-α, IFN-γ and IL-6) who experienced longer PFS (13.2 vs 8.05 months; HR: 0.42 [0.18-0.93] p = 0.02) and OS (18.04 vs 12.09 mo; HR: 0.53 [0.25-1.29] p = 0.07).Adipokines can play a crucial role to determining effectiveness of anti-cancer immunotherapy. The role of metabolic immune dysfunctions needs further pre-clinical validation and is currently investigated in the larger prospective cohort.© 2023. The Author(s).