LIPI评分评估局限期小细胞肺癌患者预后的临床价值

Clinical Value of LIPI Score in Evaluating the Prognosis of Patients with Limited-stage Small Cell Lung Cancer

目的研究治疗前肺免疫预后指数(lung immunoprognostic index,LIPI)与局限期小细胞肺癌(limited-stage small cell lung cancer,LS-SCLC)患者临床病理特征的相关性及其对预后的影响。方法回顾性分析106例LS-SCLC患者的临床及随访资料,根据治疗前血液学检查结果计算出中性粒细胞计数/(白细胞计数-中性粒细胞计数)比值(dNLR),通过建立受试者工作特征曲线(ROC)确定dNLR的最佳截断值,根据dNLR≥截断值和乳酸脱氢酶(lactate dehydroge nase,LDH)≥正常值上限两项预后因素将LIPI分为3组,即0分(0项因素)、1分(1项因素)和2分(2项因素),比较3组间临床病理学特征。利用Kaplan-Meier法和COX风险比例回归模型评估LIPI评分在预测LS-SCLC患者预后中的临床价值。结果dNLR的最佳截断值是2.05,对患者临床特征分析发现LIPI评分与N分期和KPS评分显著相关(P<0.05)。LIPI 0分、1分和2分的中位无进展生存期(progression-free survival,PFS)分别为15.3、11.0和10.0个月(P<0.05),中位总生存期(over-all survival,OS)分别为31.5、17.0和15.0个月(P<0.05)。COX多因素分析结果显示,LIPI评分和性别是影响LS-SCLC患者PFS的独立因素(P<0.05);LIPI和预防性脑照射是影响LS-SCLC患者OS的独立预后因素(P<0.05)。结论LIPI是影响LS-SCLC患者预后的独立因素,对于评估预后具有一定预测价值。

Objective To investigate the correlation between lung immunoprognostic index(LIPI)and clinicopathological features of patients with limited-stage small cell lung cancer(LS-SCLC)before treatment and its effect on prognosis.Methods The clinical and follow-up data of 106 patients with LS-SCLC were retrospectively analyzed.The neutrophils/(leukocytes minus neutrophils)ratio(dNLR)was calculated according to the results of hematology examination before treatment,and the optimal cut-off value of dNLR was determined by establishing receiver operating characteristic curve(ROC).LIPI was divided into 3 groups according to dNLR≥truncation value and lactate dehydrogenase(LDH)≥normal upper limit,0 points(0 factor),1 points(1 factor),2 points(2 factors),and the clinicopathological characteristics were compared among the 3 groups.Kaplan-Meier method and COX proportional regression model were used to evaluate the clinical value of LIPI score in predicting the prognosis of LS-SCLC patients.Results The optimal cut-off value of dNLR was 2.05.LIPI score was significantly correlated with N stage and KPS score(P<0.05).Median progression-free survival(PFS)of LIPI 0 group,1 group and 2 group were 15.3,11.0 and 10.0 months(P<0.05),and median overall survival(OS)were 31.5,17.0 and 15.0 months(P<0.05),respectively.COX multivariate analysis showed that LIPI score and gender were independent factors affecting PFS in LS-SCLC patients(P<0.05).LIPI and preventive brain irradiation were independent prognostic factors affecting OS in LS-SCLC patients(P<0.05).Conclusion LIPI is an independent factor affecting the prognosis of patients with LS-SCLC,which has certain predictive value for the evaluation of prognosis.