目的：本研究旨在分析肺癌患者在接受免疫检查点抑制剂联合化疗期间的不同治疗周期内症状体验特点和症状群的动态变化，并通过构建免疫联合化疗时的同期症状网络，探索连续治疗周期内患者的核心症状以及症状间的内在关联变化。

方法：本研究采用便利抽样法，选取2023年10月1日至2025年1月31日，于北京市某三级甲等医院初次接受免疫检查点抑制剂（ICIs）联合化疗药物治疗方案的肺癌患者。采用研究者自行设计的患者一般资料调查表，在治疗前收集患者的社会人口学和临床相关资料，并采用中文版记忆症状评估量表（MASA-Ch）在患者首次治疗结束后的第8天（T1）开始症状随访，持续随访至第6次治疗结束后的第8天（T6），记录治疗期间患者症状的发生率、发生频率、严重程度以及困扰程度。采用探索性因子分析，明确6个周期内肺癌患者症状群的数量及变化情况。运用症状网络分析技术构建症状网络模型，进而识别各症状群内的核心症状和症状内关联。

结果：本研究基线共纳入患者402名，失访43人，最后纳入患者354例。

（1）T1-T6周期内共提取出17项每个周期内发生率居前十位的症状，其中乏力、易困、没有食欲、进食口味改变和恶心5项症状的发生率＞30%，且始终位于症状前十位。全周期症状发生频率得分≥3分（“频繁”和“持续发生”）的症状共14项，其中乏力、易困、没有食欲和疼痛4项症状始终较为频繁，而T5时期没有食欲（26.55%）症状最频繁，T6时期疼痛（35.88%）症状最频繁。严重程度评分≥3分（“严重”和“很严重”）的前十位症状共提取16项，易困和没有食欲2项症状始终表现较为严重，而T5周期没有食欲（27.12%）和脱发（26.27%）较严重，T6时期疼痛（37.85%）和没有食欲（24.86%）较严重。困扰程度评分≥3分（“较大”和“很大”）的前十位症状评估中，仅有易困症状始终存在于6个周期，T1-T4及T6时期乏力症状困扰程度（37.29%～50.85%）最突出，T5时期脱发（24.85%）和疼痛（23.45%）症状最困扰。

（2）T1-T6时点共构建出5个症状群，其中T4周期症状群数量最多（4个），T2-T3周期均存在3个症状群，而T1、T5-T6最少且仅有2个症状群。饮食相关症状群持续存在于整个周期（T1-T6），感知相关症状群主要存在于T2-T3周期，而心理相关症状群除T2周期外均存在，皮肤相关症状群出现在T2和T4周期，而药物毒性症状群仅存在于T4周期。

（3）根据各周期症状群症状类型的严重程度得分构建6周期的同期网络，网络分析显示，进食口味改变（r_e=1.384～2.175，r_s=1.384～2.059）是T1至T6周期的核心症状。乏力和易困（r=0.828），皮肤瘙痒和皮肤发生改变（r=0.954），焦虑不安和精神紧张（r=0.920），没有食欲、进食口味改变和体重下降（r>0.8）4对症状间存在很强的关联性。

结论：肺癌患者接受免疫联合化疗后存在多种症状，纵向时间变化中“乏力、易困”等感知症状，与“没有食欲、进食口味改变”等饮食相关症状的发生率高，且症状最为频率、极为严重和自感较为困扰。不同时间节点上的症状聚集成5个症状群，症状群随时间推移而动态变化；症状群内核心症状随时间的推移相对稳定，且与患者症状体验的特征变化相似。医护人员可在患者治疗期间，针对稳定存在的症状群及核心症状进行干预，改善患者症状体验。

Objective: This study aims to analyse the characteristics of symptom experiences and the dynamic changes in symptom clusters among lung cancer patients during different treatment cycles while receiving immune checkpoint inhibitor combined with chemotherapy. By constructing a concurrent symptom network during immune checkpoint inhibitor combined with chemotherapy, we explore the core symptoms of patients and the intrinsic changes in symptom interactions within consecutive treatment cycles.

Methods: This study employed convenience sampling to select lung cancer patients who received initial treatment with an immunotherapy checkpoint inhibitor (ICI) combined with chemotherapy at a tertiary-level hospital in Beijing from 1 October 2023 to 31 January 2025. A patient information questionnaire designed by the researchers was used to collect sociodemographic and clinically relevant data prior to treatment. The Chinese version of the Memory and Symptom Assessment Scale (MASA-Ch) was administered starting on day 8 after the first treatment (T1) and continued until day 8 after the sixth treatment (T6), recording the incidence, frequency, severity, and distress levels of symptoms during treatment. Exploratory factor analysis was used to determine the number and changes in symptom clusters among lung cancer patients over six cycles. Symptom network analysis techniques were employed to construct a symptom network model, thereby identifying core symptoms and symptom associations within each symptom cluster.

Results: In this study, a total of 402 patients were included at the baseline. 43 patients were lost to follow-up, and finally 354 patients were included.

(1) A total of 17 symptoms that ranked among the top ten in incidence rate within each cycle from T1 to T6 were extracted. Among them, the incidence rates of five symptoms, including fatigue, drowsiness, loss of appetite, change in taste during eating, and nausea, were >30%, and these symptoms consistently ranked among the top ten symptoms. A total of 14 symptoms had a frequency score of ≥3 points ("frequent" and "continuous occurrence") for the whole cycle. Among them, four symptoms, namely fatigue, drowsiness, loss of appetite, and pain, were consistently more frequent. In the T5, the symptom of loss of appetite (26.55%) was the most frequent, and in the T6, the symptom of pain (35.88%) was the most frequent. A total of 16 symptoms among the top ten symptoms with a severity score of ≥3 points ("severe" and "very severe") were extracted. Two symptoms, drowsiness and loss of appetite, were consistently more severe. In the T5, loss of appetite (27.12%) and hair loss (26.27%) were more severe, and in the T6, pain (37.85%) and loss of appetite (24.86%) were more severe. In the assessment of the top ten symptoms with a trouble degree score of ≥3 points ("considerable" and "very large"), only the symptom of drowsiness consistently existed in all six cycles. In the T1-T4 and T6, the trouble degree of the symptom of fatigue (37.29%～50.85%) was the most prominent. In the T5, hair loss (24.85%) and pain (23.45%) were the most troubling symptoms.

(2) From time points T1 to T6, a total of 5 symptom clusters were constructed. The T4 had the largest number of symptom clusters, both the T2-T3 had 3 symptom clusters, while T1, T5-T6 had the fewest, with only 2 symptom clusters each. The diet-related symptom cluster persisted throughout the entire cycle (T1-T6). The perception-related symptom cluster mainly existed in the T2-T3. The psychology-related symptom cluster was present in all cycles except T2. The skin-related symptom cluster appeared in the T2 and T4, while the drug toxicity-related symptom cluster only existed in the T4.

(3) A concurrent network of 6 cycles was constructed based on the severity scores of symptom types in each cycle's symptom clusters. Network analysis showed that changes in eating taste (r_e=1.384～2.175, r_s=1.384～2.059) was the core symptom from T1 to T6. There was a strong correlation between four pairs of symptoms: fatigue and drowsiness (r=0.828), skin itching and skin changes (r=0.954), anxiety and mental tension (r=0.920), loss of appetite, changes in eating taste, and weight loss (>0.8).

Conclusion: Lung cancer patients who have received immunotherapy combined with chemotherapy present with a variety of symptoms. During the longitudinal time changes, perception-related symptoms such as "fatigue and drowsiness" and diet-related symptoms such as "loss of appetite and change in taste during eating" have a high incidence rate, and these symptoms occur most frequently, are extremely severe, and cause significant distress to the patients themselves. The symptoms at different time points are clustered into 5 symptom clusters, and the symptom clusters change dynamically over time. The core symptoms within the symptom clusters are relatively stable over time, and are similar to the characteristic changes in the patients' symptom experience. Medical staff can intervene in the symptom clusters and core symptoms that stably exist during the patients' treatment period to improve the patients' symptom experience.