先前的研究表明，在非小细胞肺癌（NSCLC）中，外周血CD4水平与远处肿瘤转移呈负相关。然而，CD4与远程转移的线性关系尚不清楚。因此，本研究的目的是确定NSCLC患者中CD4与远程转移之间的线性关系。本回顾性研究分析了安徽工程大学肿瘤医院2016年3月至2022年7月期间的NSCLC患者的临床和实验室数据。首先，本研究运用广义求和模型和平滑曲线拟合来确定CD4与NSCLC转移之间是否存在线性关系。其次，采用单变量 logistic 分析和多元线性回归来分析将CD4作为连续变量、二分变量和三分变量时，对于预测NSCLC转移的奥斯陆比（OR）。此外，还进行了分层和亚组分析，以评估CD4在不同NSCLC患者人群中的可靠性。本研究共纳入213名NSCLC患者，其中122例有远处转移，91例无转移。平滑曲线拟合分析显示，CD4与NSCLC转移之间存在U型关系且存在阈值效应。单变量 logistic 分析表明，连续的CD4表达与NSCLC转移无显著相关性（P=0.051）；然而，在将CD4+ T作为二分变量时（OR=0.49，P=0.010），高水平的CD4表达（≥ 35.06%）被发现是对抗NSCLC转移的保护因子。此外，多元线性回归模型显示，当将CD4+ T作为三分变量时，与中等水平（32-44%）相比，低水平（<32%）或高水平（>44%）的CD4明显增加了NSCLC转移的风险。在与年龄、性别、病理类型、吸烟、PS和T分期有关的分层分析中，有关CD4的显著性得以维持。不同远处转移部位（骨骼、大脑、肝脏）与CD4水平呈U型关系，但与肺转移无关。在NSCLC患者中，外周血CD4和远程转移之间存在阈值效应。研究发现，当CD4维持在32％至44％之间时，远程转移的风险较低，而低于32％或高于44％的CD4水平与NSCLC远程转移的风险增加相关。©2023. 作者，已授权 Springer-Verlag GmbH Germany 独家发表，属于 Springer Nature 一部分。

Prior researches indicate that peripheral blood CD4 levels have an inverse correlation with distant tumor metastasis in non-small cell lung cancer (NSCLC). However, the linear relationship between CD4 and distant metastasis lacks clarity. Hence, the objective of this study was to ascertain the linear relationship between CD4 and distant metastasis in NSCLC patients.This retrospective study analyzed clinical and laboratory data of NSCLC patients between March 2016 and July 2022 at the Cancer Hospital of Anhui University of Technology. The study first applied a generalized summation model and smoothing curve fitting to determine if there was a linear relationship between CD4 and NSCLC metastasis. Secondarily, univariate logistic analysis and multiple linear regression were used to analyze the odds ratio (OR) of CD4 as a continuous variable, dichotomous variable, and trichotomous variable when predicting NSCLC metastasis. In addition, stratified and subgroup analyses were conducted to assess the reliability of CD4 in different NSCLC patient populations.The study included a total of 213 NSCLC patients, among which 122 had distant metastasis and 91 had no metastasis. The smoothing curve fitting analysis revealed a U-shaped relationship between CD4 and NSCLC metastasis with a threshold effect. The univariate logistic analysis indicated that continuous CD4 expression was not significantly associated with NSCLC metastasis (P = 0.051); however, high levels of CD4 expression (≥ 35.06%) were found to be a protective factor against NSCLC metastasis when CD4+ T was a dichotomous variable (OR = 0.49, P = 0.010). Furthermore, multivariate linear regression models showed that low (< 32%) or high levels (> 44%) of CD4 significantly increased the risk of NSCLC metastasis compared to medium levels (32-44%) when CD4+ T was trichotomized. The significance was maintained in stratified analysis in relation to age, sex, type of pathology, smoke, PS, and T stage. CD4 levels were U-shaped in relation to different sites of distant metastases (bone, brain, liver), but not with lung metastases.A threshold effect is shown to exist between the peripheral blood CD4 and distant metastasis in NSCLC patients. It was revealed that the risk of distant metastasis is lower when CD4 is maintained between 32 and 44%, whereas low (< 32%) or high (> 44) levels of CD4 are associated with an increased risk of distant metastasis in NSCLC patients.© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.