衍生的中性粒细胞淋巴细胞比值和肺免疫预后指数对非手术老年非小细胞肺癌患者预后的影响

Effect of dNLR and LIPI scores on the prognosis of elderly patients with non-surgical treatment of non-small cell lung cancer

目的探讨衍生的中性粒细胞淋巴细胞比值(dNLR)和肺免疫预后指数(LIPI)评分对非手术治疗的老年非小细胞肺癌(NSCLC)患者预后的影响。方法回顾性收集2014年1月至2018年6月于河北省人民医院治疗的NSCLC患者的临床病理资料。根据治疗前血常规结果计算dNLR,采用受试者工作特征(ROC)曲线确定dNLR的最佳临界值,根据dNLR最佳临界值将患者分为低dNLR水平组与高dNLR水平组,依据治疗前乳酸脱氢酶(LDH)与dNLR组成的LIPI评分,划分为好、中等、差三组。生存分析采用Kaplan-Meier法和Log rank检验,预后影响因素分析采用Cox风险比例回归模型。结果dNLR预测非手术治疗老年NSCLC患者预后的ROC曲线下面积为0.591(95%CI:0.491~0.692,P=0.093),dNLR预测老年NSCLC患者预后的最佳临界值为2.515,灵敏度为45.5%,特异度为81.8%。性别、体质指数(BMI)、病理类型和肿瘤分化程度与dNLR水平有关(均P<0.05)。低dNLR水平组(dNLR<2.51)与高dNLR水平组(dNLR≥2.51)患者的中位生存时间分别为16和10个月(P<0.001);LIPI评分为好、中等、差患者的中位生存时间分别为15、10和6个月(P<0.001)。单因素分析显示,年龄、性别、吸烟、病理类型、肿瘤分化程度、临床分期、BMI、dNLR水平、LDH水平、LIPI评分与患者预后均有关(均P<0.05),年龄≥76岁、肿瘤分化程度、临床分期为Ⅲ期和Ⅳ期是患者预后的独立影响因素(均P<0.05)。结论无论采取何种非手术治疗措施,dNLR水平、LIPI评分与患者预后均有关,治疗前高dNLR水平、LIPI评分差的非手术治疗老年NSCLC患者预后较差。

Objective To investigate the effects of derived neutrophil to lymphocyte ratio(dNLR)and lung immune prognostic index(LIPI)score on the overall survival(OS)of non-surgical elderly non-small cell lung cancer(NSCLC)patients.Methods Clinical and pathological data of NSCLC patients in Hebei General Hospital from January 2014 to June 2018 were collected retrospectively.The dNLR value was calculated based on the results of blood routine before treatment,and the optimal cut-off value of dNLR was obtained by ROC curve.The patients were divided into low dNLR level group and high dNLR level group based on the optimal dNLR cut-off value.The groups were classified as good,intermediate and poor based on the LIPI score consisting of lactate dehydrogenase(LDH)and dNLR tested before treatment.The Kaplan-Meier method and Log rank test were used for survival analysis,and the Cox risk proportional regression model was used for analysis of prognostic influences.Results The area under the ROC curve for dNLR predicting prognosis in non-surgical elderly NSCLC patients was 0.591(95%CI:0.491,0.692;P=0.093).The optimal cut-off value for dNLR predicting prognosis in elderly NSCLC patients was 2.515,with a sensitivity of 45.5%and a specificity of 81.8%.The gender,BMI,pathological type and degree of tumor differentiation were associated with dNLR levels(P<0.05).The median survival times were 16 and 10 months for patients in the low dNLR level group(dNLR<2.51)and high dNLR level group(dNLR≥2.51),respectively(P<0.001),and 15,10 and 6 months for patients with good,intermediate and poor LIPI scores,respectively(P<0.001).The age,gender,smoking,pathological type,tumor differentiation,clinical stage,BMI,dNLR level,LDH level and LIPI scores were all associated with patient prognosis(P<0.05),and age≥76 years,tumor differentiation and clinical stageⅢandⅣwere independent factors influencing patient prognosis(P<0.05).Conclusion No matter what treatment measures are taken,dNLR level and LIPI score are related to patients′prognosis,and non-surgical elderly NSCLC patients with high dNLR level and poor LIPI score before treatment have worse prognoses.