C反应蛋白、中性粒细胞-淋巴细胞比率和血清白蛋白为基础的炎症预后指数对非小细胞肺癌预后作用的研究

Prognosis value of inflammatory prognostic index based on c reactive protein,neutrophil lymphocyte ratio and serum albumin in patients with non-small cell lung cancer

目的探讨C反应蛋白(C reaction protein,CRP)、中性粒细胞-淋巴细胞比率(neutrophil/Lymphocyte ratio,NLR)和血清白蛋白(serum albumin,ALB)为基础的炎症预后指数(inflammatory prognostic index,IPI)评估非小细胞肺癌(non-small cell lung cancer,NSCLC)预后的价值。方法回顾分析2009年1月至2014年12月收治的519例NSCLC患者临床和实验室检查资料,计算IPI=CRP×NLR/ALB。运用受试者特征曲线(receiver operating characteristic curve,ROC曲线)截断值分组NSCLC患者,采用Kaplan-Meiser法、单因素和多因素COX回归分析、森林图亚组分析NSCLC患者生存预后。结果 519例NSCLC患者失访74例。根据IPI的ROC截断值15将445例NSCLC患者分为高IPI组(n=217)和低IPI组(n=228)。两组肿瘤分期、肿瘤大小、原发肿瘤、区域性淋巴结、远处转移、行为状态评分(Karnofsky performance status scores,KPS)具有统计学差异(P<0.05)。低IPI组中位生存期(30个月)显著高于高IPI组(9个月,χ~2=130.8,P<0.001)。COX回归分析肿瘤分期、肿瘤大小、远处转移、KPS、NLR、ALB、CRP、IPI是影响NSCLC生存预后的独立危险因素(P<0.05)。亚组分析显示IPI是预测NSCLC患者生存预后最佳因素。结论 IPI是NSCLC患者生存预后独立风险因素;简易、廉价的IPI可用于临床实践。

Objective To investigate the prognostic value of inflammatory prognostic index( IPI) based on C reactive protein( CRP),neutrophil lymphocyte ratio( NLR) and serum albumin( ALB) in non-small cell lung cancer patients( NSCLC). Methods A retrospective review of 519 NSCLC diagnosed from January 2009 to December 2014 was conducted with clinical and laboratory data. The IPI was calculated as IPI = CRP × NLR/ALB. Receiver operating characteristic curve( ROC) cut-off values were used to divide all patients into two groups. Kaplan-Meiser,univariate and multivariate COX regression and forest plot analysis were performed to assess the prognostic value of NSCLC. Results 74 patients were lost follow-up in all NSCLC patients. The rest NSCLC patients( n = 445) were divided into two groups( the high IPI group,n = 217 vs. the low IPI group,n = 228) according ROC cut-off value of15. Tumor stage,tumor size,primary tumor,regional lymph node,distant metastases,and Karnofsky performance status scores( KPS) had significant differences between the two groups( P < 0. 05). Median overall survival was better in the low IPI group( 30 months) than the high IPI group( 9 months,χ~2= 130. 8,P < 0. 001). Tumor stage,tumor size,distant metastases,KPS,NLR,ALB,CRP,and IPI were independent prognostic factors for NSCLC overall survival by COX regression analysis( P < 0. 05). Subgroup analysis showed the IPI was a significant prognostic factor in all clinical variables. Conclusion The IPI is the independent prognostic factor of NSCLC,and the easily accessible inexpensive IPI could be useful for clinical practice.