初治时血脂水平对小细胞肺癌患者预后的影响

Effect of serum lipid level on prognosis of patients with small cell lung cancer at the initial treatment

目的探讨初治时血脂水平对小细胞肺癌(SCLC)患者预后的影响。方法回顾性分析2012—2017年吉林大学第一医院收治的129例SCLC患者的临床资料,根据中国人群血脂合适水平与异常分层标准,按初治时血脂即总胆固醇、甘油三酯、高密度脂蛋白胆固醇和低密度脂蛋白胆固醇进行分组,分析不同血脂水平与SCLC患者临床特征和预后的关系。结果 129例SCLC患者中,初治时总胆固醇<5.2 mmol/L 90例(69.8%),≥5.2 mmol/L 39例(30.2%);甘油三酯<1.7 mmol/L 95例(73.6%),≥1.7 mmol/L 34例(26.4%);高密度脂蛋白胆固醇<1.0 mmol/L 27例(20.9%),≥1.0 mmol/L 102例(79.1%);低密度脂蛋白胆固醇<3.4 mmol/L 90例(69.8%),≥3.4 mmol/L 39例(30.2%)。初治时甘油三酯水平与SCLC患者的体质指数有关(P<0.05)。SCLC患者的甘油三酯水平、临床分期与患者的中位无进展生存时间有关(均P<0.05),SCLC患者的临床分期与患者的中位总生存时间有关(P<0.05)。初治时甘油三酯<1.7 mmol/L患者的中位无进展生存时间为10.5个月,明显长于初治时甘油三酯≥1.7 mmol/L的患者(8.8个月,P=0.024)。初治时甘油三酯<1.7 mmol/L患者的中位总生存时间为20.2个月,虽长于初治时甘油三酯≥1.7 mmol/L的患者(15.6个月),但差异并无统计学意义(P=0.097)。多因素分析结果显示,初治时甘油三酯水平升高是SCLC进展的独立危险因素(P=0.022)。初治时总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇与SCLC的预后无明显相关性(均P>0.05)。结论初治时甘油三酯水平是影响SCLC患者预后的独立因素,其水平升高提示疾病进展快,预后差。

Objective To investigate the effect of serum lipid level on prognosis of patients with small cell lung cancer(SCLC)at the initial treatment.Methods The clinical data of patients with SCLC from 2012 to 2017 in our hospital were retrospectively analyzed.According to the standard of appropriate level and abnormal stratification of blood lipid in Chinese population,the lipids included total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDLC)and low-density lipoprotein cholesterol(LDLC)at the time of initial treatment were grouped.Then the relationship between different lipid levels and clinicopathological characteristics was analyzed.Finally,Cox proportional hazard model was used to analyze the independent prognostic factors of patients.Results A total of 129 patients with SCLC were included in this study.At the time of initial treatment,there were 90(69.8%)cases whose TC<5.2 mmol/L,while 39(30.2%)cases≥5.2 mmol/L;95(73.6%)cases whose TG<1.7 mmol/L,while 34(26.4%)cases≥1.7 mmol/L;27(20.9%)cases whose HDLC<1.0 mmol/L while 102 cases(79.1%)≥1.0 mmol/L;90(69.8%)cases whose LDLC<3.4 mmol/L while 39 cases(30.2%)≥3.4 mmol/L.The patients′triglyceride initial treatment was associated with their body mass index(P<0.05).The median disease-free survival(PFS)of SCLC patients was related with their serum TC level and clinical stage(P<0.05)and the overall survival(OS)was related with clinical stage of SCLC patients(P<0.05).The median PFS of SCLC patients in the TC<1.7 mmol/L group at the initial treatment was 10.5 months,significantly longer than 8.8 months of the TC≥1.7 mmol/L group(P=0.024).The median OS of SCLC patients in the TG<1.7 mmol/L group at the initial treatment was 20.2 months,marginally longer than 15.6 months of the TG≥1.7 mmol/L group(P=0.097).Multivariate analysis result showed that,the TG level was an independent risk factor of SCLC progression at the time of initial treatment(P=0.024).There was no significant correlation of TC,HDLC,LDLC and SCLC prognosis(P>0.05).Conclusion TG level is an independent risk factor for the progression of SCLC at the time of initial treatment,and the increase of TG level indicates rapid disease progression and poor prognosis.