NLR、LDH、CEA、NSE及CYFRA21-1单独及联合检测对非小细胞肺癌患者预后的预测价值

Prognostic value of individual and combined detection of NLR,LDH,CEA,NSE,and CYFRA21-1 in patients with non-small cell lung cancer

目的探讨中性粒细胞与淋巴细胞比值(NLR)、乳酸脱氢酶(LDH)、癌胚抗原(CEA)、神经元特异性烯醇化酶(NSE)及细胞角蛋白片段19(CYFRA21-1)单独或联合检测对放化疗治疗后非小细胞肺癌(NSCLC)患者预后的预测价值。方法选取行根治性放化疗治疗的进展期NSCLC患者125例,根据患者3年生存预后分为生存组(n=44)和死亡组(n=81);使用单因素及多因素logistic回归分析评价影响NSCLC根治性放化疗预后的相关因素,绘制受试者工作特性曲线(ROC)曲线下面积(AUC)评价NLR、LDH、CEA、NSE及CYFRA21-1单独或联合对NSCLC根治性放化疗预后的预测效能。结果单因素分析结果显示,生存组的高分化肿瘤、靶向治疗占比高于死亡组(P<0.05),肿瘤淋巴结转移(TNM)分期为Ⅳ期占比低于死亡组(P<0.05),NLR、LDH、CEA、NSE及CYFRA21-1低于死亡组(P<0.05);logistic回归分析结果显示,TNM分期和NLR、LDH、CEA、NSE、CYFRA21-1是NSCLC根治性放化疗预后的独立危险因素(P<0.05),肿瘤分化程度、靶向治疗是NSCLC根治性放化疗预后的独立保护因素(P<0.05);ROC结果发现NLR、LDH、CEA、NSE、CYFRA21-1水平对NSCLC根治性放化疗预后均有一定预测效能,AUC分别为0.780、0.886、0.863、0.766及0.779,5项指标联合的AUC最高(0.946)。结论外周血NLR、LDH、CEA、NSE及CYFRA21-1升高对进展期NSCLC根治性放化疗患者不良预后有一定的预测价值,5项指标联合检测具有更高的预测价值。

Objective To explore the prognostic value of individual and combined detection of neutrophil to lymphocyte ratio(NLR),lactate dehydrogenase(LDH),carcino-embryonic antigen(CEA),neuron-specific enolase(NSE),and cytokeratin 19-fragments(CYFRA21-1)in non-small cell lung cancer(NSCLC).Methods A total of 125 patients with advanced NSCLC who received radical radiotherapy and chemotherapy was selected.According to the 3-year survival prognosis of the patients,they were divided into the survival group(n=44)and the death group(n=81).Univariate and multivariate logistic regression analysis was used to evaluate the factors affecting the prognosis of radical radiotherapy and chemotherapy in NSCLC,and area under the curve(AUC)of the receiver operating characteristic curve(ROC)was used to evaluate the efficacy of individual and combined detection of NLR,LDH,CEA,NSE,and CYFRA21-1 in predicting the prognosis of radical radiotherapy and chemotherapy in NSCLC.Results Univariate analysis showed that the highly differentiation degree and targeted therapy ratio of survival group were higher than those of death group(P<0.05),the proportion of TNM stageⅣwas lower than that of death group(P<0.05),and NLR,LDH,CEA,NSE and CYFRA21-1 were lower than those of death group(P<0.05).Logistic regression analysis showed that TNM stage,NLR,LDH,CEA,NSE,and CYFRA21-1 were independent risk factors for the prognosis of radical radiotherapy and chemotherapy in NSCLC(P<0.05),while degree of differentiation and targeted therapy were independent protective factors for the prognosis of radical radiotherapy and chemotherapy in NSCLC(P<0.05),and tumor differentiation degree and targeted therapy were independent protective factors for the prognosis of radical radiotherapy and chemotherapy in NSCLC(P<0.05);ROC showed that NLR,LDH,CEA,NSE,and CYFRA21-1 all had certain predictive efficacy for the prognosis of radical radiotherapy and chemotherapy in NSCLC,AUC were 0.780,0.886,0.863,0.766,and 0.779,respectively,and AUC of the five factors combined was 0.946,which was the largest.Conclusion The elevations of NLR,LDH,CEA,NSE,and CYFRA21-1 in peripheral blood have predictive values in adverse prognosis after radical radiotherapy and chemotherapy in patients with advanced NSCLC,and their combined detection has a better predictive effect.