基线HALP评分和相关炎性指标与晚期肾透明细胞癌患者预后的关系

Correlation between baseline HALP score and related inflammatory indicators and the prognosis of patients with advanced clear cell renal cell carcinoma

目的:探索基线HALP评分和相关炎性指标与晚期肾透明细胞癌(ccRCC)患者预后的关系。方法:回顾2010年至2018年我院收治的AJCC分期Ⅲ期以上的ccRCC患者111例,收集患者病历资料并随访至2023年6月30日,采用ROC曲线分析HALP评分及相关指标预测患者预后的曲线下面积和最佳截断值,Kaplan-Meier法绘制生存曲线,Log-rank检验和Cox回归分析影响患者预后的可能因素。结果:随访时间63(55,74)个月,随访期内死亡占比29.73%(33/111),总生存时间(OS)和无进展生存时间(PFS)分别为51(41,60)个月和47(35,56)个月,患者3年和5年总生存率分别为84.68%和70.27%,3年和5年无进展生存率分别为77.48%和70.27%。HALP评分、NLR、PLR和LMR预测患者预后曲线下面积(AUC)分别为0.920、0.865、0.859和0.848,最佳截断值分别为48.0、3.05、88.9和4.43。治疗手段(以姑息治疗为参照)、AJCC分期、HALP评分和NLR等4个因素与患者OS有关,其HR分别为0.034(手术治疗)、0.058(免疫治疗)、2.196(AJCC分期为Ⅳ期)、12.532(HALP<48.0)和0.264(NLR<3.05);治疗手段(以姑息治疗为参照)、HALP评分和NLR等3个因素与患者PFS有关,其HR分别为0.046(手术治疗)、0.073(免疫治疗)、12.352(HALP<48.0)和0.252(NLR<3.05)。结论:晚期ccRCC预后状况可能与机体营养、免疫和炎症状况有关,HALP评分、NLR和治疗手段是患者预后的重要影响因素和预测因子。

Objective:To explore the relationship between baseline hemoglobin,albumin,lymphocyte and platelet(HALP)score and related inflammatory indicators and the prognosis of patients with advanced clear cell renal cell carcinoma(ccRCC).Methods:A retrospective study was conducted on 111 patients with AJCC stage III or above ccRCC admitted to our hospital from 2010 to 2018.Patient medical records were collected and followed up until June 30,2023.ROC curve analysis was used to calculate the area under the curve(AUC)and optimal cutoff value of HALP scores and related indicators for predicting patient prognosis.Kaplan-Meier method was used to draw survival curves.Log-rank test and Cox regression analysis were used to explore possible factors affecting patient prognosis.Results:The follow-up period was 63(55,74)months,and the proportion of deaths during the follow-up period was 29.73%(33/111).The overall survival time(OS)and progression-free survival time(PFS)were 51(41,60)months and 47(35,56)months,respectively.The 3-year and 5-year overall survival rates of patients were 84.68%and 70.27%,respectively.The 3-year and 5-year progression-free survival rates were 77.48%and 70.27%,respectively.The AUC of HALP score,NLR,PLR,and LMR in predicting prognosis was 0.920,0.865,0.859,and 0.848 with the optimal cutoff values at 48.0,3.05,88.9,and 4.43,respectively.The treatment method(relative to palliative treatment),AJCC stage,HALP score,and NLR were related to the OS of patients,with HR values of 0.034(surgical treatment),0.058(immunotherapy),2.196(AJCC stage IV),12.532(HALP<48.0),and 0.264(NLR<3.05),respectively.Treatment method(relative to palliative treatment),HALP scores,and NLR were related to patient PFS,with HR values of 0.046(surgical treatment),0.073(immunotherapy),12.352(HALP<48.0),and 0.252(NLR<3.05),respectively.Conclusion:The prognosis of advanced ccRCC may be related to the body's nutritional,immune,and inflammatory status.HALP score,NLR,and treatment methods are important influencing factors and predictive factors for patient prognosis.