摘要
目的分析全身免疫营养炎症指标[中性粒细胞-淋巴细胞比率(NLR)和预后营养指数(PNI)]预测程序性细胞死亡1(PD-1)免疫治疗肺腺癌的效果。方法选取接受纳武单抗治疗的非小细胞肺癌(NSCLC)患者138例、良性肺结节患者97例、健康志愿者94例为研究对象,比较3组NLR、PNI、白细胞、中性粒细胞、淋巴细胞、白蛋白(ALB)、癌胚抗原(CEA)水平。采用Cox回归模型分析NSCLC患者预后不良的独立影响因素,采用Spearman相关性分析TNM分期、NLR、CEA、PNI之间的关系,采用生成受试者操作曲线(ROC)评估TNM分期、NLR、CEA、PNI对NSCLC患者预后不良的预测价值。结果NSCLC患者白细胞、中性粒细胞、淋巴细胞、NLR、ALB、CEA水平显著高于良性肺结节患者和健康志愿者(P<0.05),PNI显著低于良性肺结节患者和健康志愿者(P<0.05)。NLR(OR=1.156,95%CI=1.026~1.303)、PNI(OR=0.976,95%CI=0.955~0.996)、CEA(OR=1.001,95%CI=1.000~1.001)、TNM分期(OR=2.531,95%CI=1.205~5.317)是接受纳武单抗治疗NSCLC患者预后不良的独立影响因素(P<0.05)。Spearman相关性分析显示,TNM分期与NLR、CEA呈显著正相关(r=0.284、0.597,P<0.001),与PNI呈显著负相关(r=-0.167,P<0.05);NLR与CEA呈显著正相关(r=0.209,P<0.05),与PNI呈显著负相关(r=-0.693,P<0.01)。ROC曲线显示,NLR、PNI、CEA、TNM分期及联合检测对接受纳武单抗治疗的NSCLC患者预后AUC值分别为0.840(95%CI=0.773~0.907)、0.611(95%CI=0.512~0.711)、0.662(95%CI=0.570~0.754)、0.835(95%CI=0.769~0.901)、0.884(95%CI=0.824~0.944)。结论NLR、PNI可作为简单、廉价和有效的生物标志物用于评估接受纳武单抗治疗NSCLC患者的不良预后,有助于临床医生确定需要严密监测的高危患者。
Objective To analyze the effect of systemic immune-nutrition-inflammation indexes[neutrophil-lymphocyte ratio(NLR)and prognostic nutritional index(PNI)]in predicting programmed cell death 1(PD-1)immunotherapy for non-small cell lung cancer.Methods A total of 138 patients with non-small cell lung cancer(NSCLC)treated with navuzumab,97 patients with benign pulmonary nodules,and 94 healthy volunteers were selected for the study.The levels of NLR,PNI,white blood cells,neutrophils,lymphocytes,albumin(ALB),and carcinoembryonic antigen(CEA)were compared among the three groups.Cox regression model was used to analyze the independent influencing factors of poor prognosis in NSCLC patients;Spearman correlation was used to analyze the relationship between TNM stage,NLR,CEA,and PNI;the receiver operator characteristic curve(ROC)was used to assess the predictive value of TNM stage,NLR,CEA,and PNI on poor prognosis in NSCLC patients.Results The levels of white blood cells,neutrophils,lymphocytes,NLR,ALB and CEA in NSCLC patients were significantly higher than those in patients with benign pulmonary nodules and healthy volunteers(P<0.05),whereas the levels of PNI were significantly lower than those in patients with benign pulmonary nodules and healthy volunteers(P<0.05).The NLR(OR=1.156,95%CI=1.026-1.303),PNI(OR=0.976,95%CI=0.955-0.996),CEA(OR=1.001,95%CI=1.000-1.001)and TNM(OR=2.531,95%CI=1.205-5.317)were the independent influencing factors for poor prognosis of NSCLC patients receiving navuzumab(P<0.05).Spearman correlation analysis showed that TNM staging was positively correlated with NLR and CEA(r=0.284,0.597,P<0.001)and negatively correlated with PNI(r=-0.167,P<0.05);NLR was positively correlated with CEA(r=0.209,P<0.05)and negatively correlated with PNI(r=-0.693,P<0.01).The ROC curves showed that the prognostic AUC values of NLR,PNI,CEA,TNM staging and combined tests for NSCLC patients treated with navuzumab were 0.840(95%CI=0.773-0.907),0.611(95%CI=0.512-0.711),0.662(95%CI=0.570-0.754),0.835(95%CI=0.769-0.901),and 0.884(95%CI=0.824-0.944),respectively.Conclusions NLR,PNI can be used as simple,inexpensive and effective biomarkers for assessing poor prognosis in patients with NSCLC treated with nabumab,which can help clinicians to identify high-risk patients who require close monitoring.
作者
马婷
李君哲
黄良玖
林君
MA Ting;LI Jun-zhe;HUANG Liang-jiu;LIN Jun(Department of Pharmacy,Hainan Provincial Cancer Hospital/the Affiliated Cancer Hospital of Hainan Medical College,Haikou 570000,China)
出处
《南昌大学学报(医学版)》
2024年第5期69-73,80,共6页
Journal of Nanchang University:Medical Sciences
基金
海南省卫生健康行业科研项目(A202B1134)。