炎症预后指数与不可手术的局部晚期(Ⅲ_(a)和Ⅲ_(b)期)非小细胞肺癌患者预后的关系

The correlation between inflammatory prognostic index and prognosis in patients with inoperable locally advanced(stageⅢ_(a)andⅢ_(b))non-small cell lung cancer

目的:探讨炎症预后指数(inflammatory prognostic index,IPI)与不可手术的局部晚期(Ⅲ_(a)和Ⅲ_(b)期)非小细胞肺癌(non-small cell lung cancer,NSCLC)患者预后的关系。方法:回顾性分析2011年01月至2016年12月358例就诊于我院的局部晚期(Ⅲ_(a)和Ⅲ_(b)期)NSCLC患者的临床病理资料,获取患者治疗前1个月内的血常规、C反应蛋白(C-reactive protein,CRP)、血清白蛋白(serum albumin,ALB)检测结果,并根据血常规中的淋巴细胞计数、白细胞计数、CRP及ALB计算IPI,公式为IPI=CRP×NLR/ALB。采用Kaplan-Meier生存分析及Cox回归分析探讨影响患者生存的因素。结果:采用Xtile计算界值为113,并根据该界值将IPI分为低IPI组(145例)和高IPI组(213例)。两组患者间的年龄、性别、吸烟状态、KPS评分、病理分型和疾病分期等差异均无统计学意义(均P>0.05)。低IPI组患者的生存明显优于高IPI组[47个月(95%CI 32~NA)vs 27个月(95%CI 22~NA)],两组间差异有统计学意义(P=0.0066)。低IPI组患者的2年生存率也优于高IPI组,分别为65.8%(57.9%~74.9%)和52.7%(45.8%~60.5%)。Cox多因素回归分析提示,年龄(P=0.000)、吸烟状态(P=0.040)和IPI指数(P=0.006)均为影响NSCLC患者OS的独立危险因素。结论:IPI是不可手术的局部晚期(Ⅲ_(a)和Ⅲ_(b)期)NSCLC患者预后的独立危险因素。

Objective:To investigate the relationship between inflammatory prognostic index(IPI)and the prognosis of patients with inoperable locally advanced(stageⅢ_(a)andⅢ_(b))non-small cell lung cancer.Methods:We retrospectively analyzed the clinical and pathological data from 358 patients with locally advanced(stageⅢ_(a)andⅢ_(b))non-small cell lung cancer between January 2011 and December 2016 in our hospital.Complete blood count,C-reaction protein,albumin within one month before treatment were recorded to calculate the baseline IPI.Survival curves were generated using the Kaplan-Meier method,and Cox regression models were used to determine whether the patient baseline characteristics and/or IPI were associated with OS.Results:Patients were divided into low-IPI group(145 cases)and high-IPI group(213 cases)with a cut-off value of 113 calculated by Xtile.No significant difference was noted in baseline age,gender,smoking status,KPS score,pathological classification and disease stage(all P>0.05)between two groups.By data cut-off,low IPI was associated with a significantly improved OS than those with high IPI[47 months(95%CI 32~NA)vs 27 months(95%CI 22~NA),P=0.0066].Cox multivariate regression analysis showed that age(P=0.000),smoking status(P=0.040),and IPI(P=0.006)were independent risk factors for OS in inoperable locally advanced NSCLC patients.Conclusion:IPI is an independent risk factor for prognosis in patients with inoperable locally advanced(stageⅢ_(a)andⅢ_(b))non-small cell lung cancer.