总胆红素及其与直接胆红素的比值对广泛期小细胞肺癌患者预后的预测价值

Predictive value of total bilirubin and its ratio to direct bilirubin in the prognosis of patients with extensive-stage small cell lung cancer

目的评估总胆红素与直接胆红素及二者的比值对广泛期小细胞肺癌(ES-SCLC)患者预后的预测价值。方法选取中国人民解放军联勤保障部队第九○一医院2018年1月至2020年7月收治的83例ES-SCLC患者为研究对象。收集患者入院时临床资料、生化检验、无进展生存期(PFS)和总生存期(OS)等。采用多因素Cox回归分析胆红素对ES-SCLC患者生存预后的影响,用Kaplan-Meier方法评估生存时间。结果总胆红素和总胆红素/直接胆红素对ES-SCLC患者生存预后具有预测价值(P<0.05),最佳截断值分别是12.3μmol/L和2.8;与低总胆红素组(≤12.3μmol/L)患者比较,高总胆红素组(>12.3μmol/L)患者有更长的中位PFS和OS(P<0.05);与低总胆红素/直接胆红素组(≤2.8)患者比较,高总胆红素/直接胆红素组(>2.8)患者有更长的中位PFS和OS(P<0.05);总胆红素和总胆红素/直接胆红素是影响ES-SCLC患者独立预后因素(P<0.05)。结论总胆红素水平和总胆红素/直接胆红素水平可能是ES-SCLC的重要预后因素,有助于判断患者的预后。

Objective To evaluate the predictive value of total bilirubin to direct bilirubin and the ratio of the two in the prognosis of patients with extensive-stage small cell lung cancer(ES-SCLC).Methods A total of 83 ES-SCLC patients admitted to the 901 st Hospital of the Joint Service Support Force of the Chinese People’s Liberation Army from January 2018 to July 2020 were selected as the research objects.Clinical data,biochemical tests,progression-free survival(PFS)and overall survival(OS)of patients upon admission were collected.Multivariate Cox regression was used to analyze the effect of bilirubin on the survival and prognosis of ES-SCLC patients,and the Kaplan-Meier method was used to evaluate the survival time.Results Total bilirubin and total bilirubin/direct bilirubin had predictive value for the survival and prognosis of ES-SCLC patients(P<0.05),and the best cut-off values were 12.3μmol/L and 2.8,respectively;compared with patients in the low total bilirubin group(≤12.3μmol/L),patients in the high total bilirubin group(>12.3μmol/L)had longer median PFS and OS(P<0.05);compared with patients in the low total bilirubin/direct bilirubin group(≤2.8),patients in the high total bilirubin/direct bilirubin group(>2.8)had longer median PFS and OS(P<0.05);total bilirubin and total bilirubin/direct bilirubin were independent prognostic factors affecting ES-SCLC patients(P<0.05).Conclusion Total bilirubin level and total bilirubin/direct bilirubin level may be important prognostic factors of ES-SCLC,which can help determine the prognosis of patients.