血清胆碱酯酶和中性粒细胞淋巴细胞比值对老年非小细胞肺癌预后的评估作用研究

Study on the prognostic value of serum cholinesterase and neutrophil/lymphocyte ratio in elderly patients with non-small cell lung cancer

目的 探讨血清胆碱酯酶、中性粒细胞与淋巴细胞比值(NLR)对老年非小细胞肺癌(NSCLC)预后的评估作用。方法 选择2017年1月—2019年12月空军军医大学第二附属医院明确诊断的149例老年NSCLC为研究对象。收集患者的临床和病理学资料,并对患者进行随访,随访终点为总生存期(OS)。通过单因素和多因素Cox回归明确影响患者OS的独立危险因素。结果 患者中位随访30 (四分位区间22~37)个月,共计99例(66.44%)患者达随访终点。与血清胆碱酯酶>7 800 U/L组比较,血清胆碱酯酶≤7 800 U/L组患者年龄更大、 TNMⅢ~Ⅳ期比例更高、接受手术比例更低,且ECOG体能评分状态更差,NLR更高。与NLR≤5.83组比较,NLR>5.83组患者年龄更大、 TNMⅢ~Ⅳ期比例更高、 ECOG体能评分状态更差且血清胆碱酯酶活性更低。血清胆碱酯酶≤7 800 U/L组患者中位生存期显著短于>7 800 U/L组(31个月vs 35个月,P=0.02);NLR>5.83组患者中位生存期显著短于低NLR≤5.83组(30个月vs 35个月,P=0.03)。多因素Cox回归校正混杂因素后,NLR>5.83和血清胆碱酯酶≤7 800 U/L仍是患者预后不良的独立危险因素。结论 血清胆碱酯酶活性和NLR与老年NSCLC预后密切相关,具有潜在的预后评估意义。

Objective To investigate the prognostic value of serum cholinesterase and neutrophil/lymphocyte ratio in elderly patients with non-small cell lung cancer(NSCLC).Methods A total of 149 elderly NSCLC patients diagnosed in Second Affiliated Hospital of Air Force Military Medical University from January 2017 to December 2019 were selected as the study subjects.Their clinical and pathological data were collected.They were followed up and the end point of follow-up was overall survival(OS).Univariate and multivariate Cox regression were used to identify the independent risk factors affecting patients’ OS.Results The median follow-up period was 30(interquartile range 22-37) months,and 99 patients(66.44%) reached the end point of follow-up.Compared with patients in the serum cholinesterase>7 800 U/L group,patients in the serum cholinesterase ≤7 800 U/L group were older,and had a higher proportion of TNM stage Ⅲ-Ⅳ,lower proportion of surgery,worse ECOG performance status,and higher NLR.Compared with patients in the NLR≤5.83 group,patients in the NLR>5.83 group were older,and had a higher proportion of TNM stage Ⅲ-Ⅳ,worse ECOG performance status,and lower serum cholinesterase activity.The median survival time of patients in the serum cholinesterase≤7 800 U/L group was significantly shorter than that of patients in the serum cholinesterase>7 800 U/L group(31 months vs 35 months,P=0.02);the median survival time of patients in the NLR>5.83 group was significantly shorter than that of patients in the low NLR≤ 5.83 group(30 months vs 35 months,P=0.03).After adjusting for confounding factors by multivariate Cox regression,NLR>5.83 and serum cholinesterase ≤ 7 800 U/L were still independent risk factors for poor prognosis.Conclusion Serum cholinesterase activity and NLR are closely related to the prognosis of elderly NSCLC patients,which has potential prognostic evaluation significance.