非小细胞肺癌胸腔镜根治性切除术后早期炎症反应和营养状况对其预后的影响

Effects of Early Inflammatory Response and Nutritional Status after Thoracoscopic Radical Resection on Prognosis of Patients with Non-small Cell Lung Cancer

目的探讨胸腔镜根治性切除术后早期炎症反应和营养状况对非小细胞肺癌(NSCLC)患者预后的影响。方法回顾性分析120例胸腔镜根治切除术后NSCLC患者的临床资料。根据相应标准,分为mGPS 0分、1分及2分组,OPNI、NLR、MLR和PLR高分组与低分组。采用Kaplan-Meier法及Log-rank检验进行生存分析,并采用单因素和多因素Cox回归模型分析预后影响因素,探讨OPNI评分与NLR、MLR和PLR的相关性。结果mGPS 0、1及2分组3年OS分别为83.3%、83.3%、58.3%(P=0.011),3年PFS分别为73.7%、50.0%、50.0%(P=0.029)。PLR低分组和高分组3年OS分别为86.4%、70.0%(P=0.018),差异有统计学意义;PLR低分组和高分组3年PFS分别为73.2%、60.0%(P=0.136),差异无统计学意义。OPNI低分组和高分组3年OS分别为73.3%、83.2%(P=0.181),3年PFS分别为58.6%、74.1%(P=0.119),差异无统计学意义。NLR低分组和高分组3年OS分别为83.3%、73.2%(P=0.183),3年PFS分别为73.3%、60.0%(P=0.146),差异无统计学意义。MLR低分组和高分组3年OS分别为83.3%、73.2%(P=0.138),3年PFS分别为73.3%、60.0%(P=0.146),差异无统计学意义。OPNI与NLR(R=-0.634,P<0.001)和MLR(R=-0.634,P<0.001)为强负相关,与PLR(R=-0.434,P<0.001)为中等强负相关。多因素分析显示肿瘤部位(HR=0.147,95%CI 0.046~0.468,P=0.001)、肿瘤分期(Ⅱ期vsⅠ期,HR=5.030,95%CI 1.335~18.951,P=0.017;Ⅲ期vsⅠ期,HR=6.541,95%CI 1.612~26.540,P=0.009)和mGPS(2分组vs 0分组,HR=4.234,95%CI 1.639~10.937,P=0.003)是影响NSCLC患者生存预后的独立影响因素。结论mGPS 0分组患者具有显著的生存获益。肿瘤部位、肿瘤分期和mGPS 2分组是胸腔镜根治性切除NSCLC患者生存预后的独立影响因素。

Objective To explore the effect of early postoperative inflammatory response and nutritional status on the prognosis of patients with radical resection by thoracectomy of NSCLC.Methods A total of 120 cases of NSCLC after thoracoscopic lung cancer resection were respectively analyzed.The patients were divided into 11 groups.They included three groups(mGPS 0,1 and 2),and eight groups(high and low score groups of OPNI,NLR,MLR and PLR).Kaplan-Meier and Log-rank were used to test survival analysis and univariate and multivariate Cox regression models were used to analyze the prognostic factors.The correlations between OPNI score and NLR,MLR and PLR indexes were discussed.Results The 3-year OS of mGPS 0 group, 1 group and 2 group were 83.3%,83.3% and 58.3%,respectively,(P=0.011)and the 3-year PFS were 73.7%,50.0%,and 50.0%,respectively(P=0.029).The 3-year OS of low and high PLR groups were 86.4% vs 70.0%(P=0.018).The 3-year PFS of low and high PLR groups were 73.2% vs 60.0%(P=0.136).There was no significant difference in PLR group.The 3-year OS of low and high OPNI groups were 73.3% vs 83.2%(P=0.181),and the 3-year PFS were 58.6% vs 74.1%(P=0.119).There was no significant difference in OS and PFS between OPNI group.The 3-year OS of low and high NLR groups were 83.3% vs 73.2%(P=0.183),and the 3-year PFS were 73.3% vs 60.0%(P=0.146).There was no significant difference in OS and PFS between NLR group.OPNI was strongly negatively correlated with NLR(R=-0.634,P<0.001)and MLR(R=-0.634,P<0.001),and moderately negatively correlated with PLR(R=-0.434,P<0.001).Multivariate analysis showed that tumor location(HR=0.147,95% CI 0.046-0.468,P=0.001),tumor stage(phase Ⅱ vs phase Ⅰ,HR=5.030,95%CI 1.335-18.951,P=0.017;phase Ⅲ vs phase Ⅰ,HR=6.541,95%CI 1.612-26.540,P=0.009)and mGPS(2 points vs 0 points, HR=4.234,95%CI 1.639-10.937,P=0.003)were independent prognostic factors for survival of NSCLC patients with radical resection by thoracectomy.Conclusion The results of this study showed that patients in MGPS 0 group can significantly improve the OS of NSCLC patients with radical resection by thoracectomy.Tumor location, tumor stage and mGPS 2 points were independent prognostic factors for survival of these NSCLC patients.