治疗前HALP评分对Ⅳ期无驱动基因NSCLC患者的预后意义

Prognostic significance of the pre-treatment HALP score in patients with stage IV non-small cell lung cancer without a driver gene

目的:探究Ⅳ期无驱动基因非小细胞肺癌(non-small cell lung cancer,NSCLC)患者治疗前血红蛋白、白蛋白水平、淋巴细胞和血小板计数(HALP)联合检测的预后意义。方法:回顾性分析我院167例2017年3月-2019年12月符合入组标准的NSCLC患者临床病理资料。利用X-Tiles软件计算出HALP评分的最佳临界值,将患者分为低HALP组与高HALP组;应用Kaplan-Meier方法进行生存分析,单因素和Cox多因素分析确定与无进展生存期(progression-free survival,PFS)相关的因素。结果:通过X-Tiles软件确定HALP评分的最佳临界值为27.7,低HALP组(<27.7)70例,高HALP组(≥27.7)97例,HALP值与患者的BMI,KPS评分,T分期,远处转移,化疗疗程数,贫血与否,白蛋白值的组间差异有统计学意义(均P<0.05),而在性别,年龄,吸烟与否,病理类型,N分期的组间无显著差异(P>0.05)。患者治疗后治疗获益(disease control rate,DCR)组和疾病进展(progressive disease,PD)组的HALP评分具有明显差异(P<0.05),低HALP组与高HALP组的中位PFS时间差异有统计学意义(5个月vs 7个月,P=0.003)。单因素分析显示KPS评分、BMI、T分期、N分期、远处转移、化疗疗程数、治疗前HALP评分、白蛋白值、贫血与否是患者预后的影响因素(P<0.05)。多因素分析可见KPS评分、T分期、远处转移、化疗疗程数、治疗前HALP评分、白蛋白值、贫血与否是独立危险因素(P<0.05)。结论:在接受化疗联合恩度的Ⅳ期驱动基因阴性的非小细胞肺癌患者中,HALP评分对疗效及预后有一定的预测作用,低水平的HALP值可能提示非小细胞肺癌预后差。

Objective:To investigate the prognostic significance of the novel index combining pre-treatment hemoglobin and albumin levels and lymphocyte and platelet counts(HALP)in patiants with stage IV non-small cell lung cancer(NSCLC)without a driver gene.Methods:Clinical and pathological data of 167 NSCLC patients who met the inclusion criteria from March 2017 to December 2019 in our hospital were retrospectively analyzed.The optimal cut-off values of the HALP score was determined by X-tile software.The patients were divided into the group with low HALP score and the group with high HALP score.Kaplan-Meier method was used for survival analysis.Univariate and Cox multivariate analysis were used to identify the factors associated with progression-free survival(PFS).Results:The optimal cut-off values of the HALP score was determined by X-tile software to be 27.7.70 patients in the low HALP group(<27.7)and 97 patients in the high HALP group(≥27.7).HALP was associated with BMI,KPS score,T stage,distant metastases,number of chemotherapy,anemia or not and albumin values(all P<0.05).while there were no significant differences among groups in patients'gender,age,smoking or not,pathological type and N stage(P>0.05).There were statistically significant differences in HALP score between the disease control rate(DCR)group and the progressive disease(PD)group after chemotherapy(P<0.05).There was a statistically significant difference in median PFS time between the low HALP group and the high HALP group(5 months vs 7 months,P=0.003).Univariate analysis showed that BMI,KPS score,T stage,N stage,distant metastases,number of chemotherapy,anemia or not,albumin values,the HALP score before treatment were influential factors for prognosis(P<0.05).According to the multivariate analysis,KPS score,T stage,distant metastases,number of chemotherapy,anemia or not,albumin values,the HALP score before treatment were independent risk factors for prognosis(P<0.05).Conclusion:In stageⅣNSCLC without a driver gene patients undergoing chemotherapy combined with endostatin,the HALP score has a certain predictive significance on the efficacy and prognosis,low levels of HALP score may be a significant risk factor for PFS in NSCLC patients.