间接胆红素—炎症评分对鼻咽癌患者的预后预测价值

The prognostic predictive value of indirect bilirubin-inflammation score in patients with nasopharyngeal carcinoma

目的:建立一个基于间接胆红素和炎症标志物〔包括中性粒细胞与淋巴细胞比值(NLR)、淋巴细胞与单核细胞比值(LMR)和血小板与淋巴细胞比值(PLR)〕的有效预后模型,以预测鼻咽癌患者的生存情况。方法:回顾性分析688例鼻咽癌患者治疗前的血液学指标,包括间接胆红素以及外周血细胞参数;随机分为训练集481例和测试集207例。采用机器学习构建间接胆红素—炎症(IBI)评分,建立列线图;通过一致性指数(C指数)、时间相关接收器工作特性(ROC)曲线和决策曲线分析(DCA)来衡量预测模型的性能;进一步分析各指标之间的交互作用和中介效应。结果:比对14种机器学习算法,选择最优模型倾斜随机生存森林构建IBI评分。训练集、测试集和全集的IBI评分C指数分别为0.722、0.564和0.672;全集的1年、3年及5年时间依赖性ROC曲线下面积分别为0.762、0.712及0.705。IBI评分与患者的肿瘤TNM分期呈显著正相关关系(P<0.05)。联合性别、年龄、临床分期以及IBI评分等指标建立的列线图,经DCA评估,显示出良好的临床实用性和预测能力。间接胆红素与PLR之间存在显著的交互作用。在间接胆红素对鼻咽癌生存影响方面,炎症指标未表现出中介效应。结论:IBI评分作为鼻咽癌患者的潜在预后因子,具有检测便利和经济优势,可为鼻咽癌的个性化预后预测和临床制定治疗策略提供依据。

Objective:To construct an effective prognostic model based on indirect bilirubin(IBIL)and inflammatory markers,including neutrophil-to-lymphocyte ratio(NLR),lymphocyte-to-monocyte ratio(LMR),and platelet-to-lymphocyte ratio(PLR),to predict overall survival(OS)in patients with nasopharyngeal carcinoma(NPC).Methods:Hematological parameters,including IBIL and parameters of peripheral blood cells,were retrospectively analyzed in 688 NPC patients before treatment.These patients were randomly divided into a training set(n=481)and a test set(n=207).The IBIL-inflammation(IBI)score was developed using the machine learning.A nomogram was established,and the performance of the prediction model was measured by the concordance index(C-index),time-dependent receiver operating characteristic(ROC)curve,and decision curve analysis(DCA).The interaction and mediation between the biomarkers were further analyzed.Results:By comparing 14 types of machine learning algorithms,the optimal model,oblique random survival forest,was selected to construct IBI score.The C-index of the IBI score was 0.722 in the training set,0.564 in the test set,and 0.672 in the entire set.The area under the curve of time-dependent ROC at 1,3,and 5 years was 0.762,0.712,and 0.705 in the entire set respectively.IBI score was significantly positively correlated with clinical TNM stage(P<0.05).The nomogram,which integrated age,sex,clinical stage,and IBI score,demonstrated good clinical utility and predictive ability,as evaluated by the DCA.Significant interaction was found between IBIL and PLR,and inflammatory markers did not exhibit any medicating effects on the influence of IBIL on NPC survival.Conclusion:The IBI score,as a potential prognostic factor for NPC patients,offers advantages in convenience and cost-effectiveness for detection.It can provide a basis for personalized prognostic predictions and the formulation of clinical treatment strategies for NPC.