老年晚期肺癌242例炎症指标和营养风险指数与预后的关系初探

Preliminary study on relationship between inflammatory markers,nutritional risk index and prognosis in 242 elderly patients with advanced lung cancer

中文关键词: 老年  晚期肺癌  中性粒细胞/淋巴细胞比值  营养风险指数  预后

英文关键词: elderly  advanced lung cancer  neutrophil-to-lymphocyte ratio  nutritional risk index  prognosis

中文摘要:

      目的 探讨老年晚期肺癌患者初诊时外周血炎症指标[中性粒细胞/淋巴细胞比值(NLR)、血小板/淋巴细胞比值(PLR)]和营养风险指数(GNRI)与预后的关系.方法 选取2021年2月至2023年6月入院诊治的老年晚期肺癌患者242例为研究对象,观察不同分化程度和有否淋巴转移患者的NLR、PLR、GNRI水平,采用Kaplan-Meier生存曲线进行生存分析,受试者操作特征(ROC)曲线分析NLR、PLR、GNRI水平及其联合检测对患者预后(无进展生存)的预测价值,COX风险比例回归分析影响患者无进展生存时间因素.结果 低分化老年晚期肺癌患者的NLR和PLR水平高于中高分化者,GNRI水平低于中高分化者(P＜0.05);发生淋巴结转移者NLR和PLR水平高于未发生转移者,而GNRI水平低于未发生转移者(P＜0.05).随访时间为12～42个月,242例老年晚期肺癌患者累积总生存率为66.94％(162/242),无进展生存率为64.05％(155/242).ROC曲线分析显示,NLR、PLR、GNRI及其联合检测对老年晚期肺癌患者预后的预测曲线下面积分别为0.761、0.890、0.882和0.860,截断值分别为4.39、221.50、96分.多因素COX回归分析显示,淋巴结转移、NLR≥4.39,PLR≥221.50均为影响老年晚期肺癌患者预后的独立危险因素(P＜0.05),而GNRI≥96分为保护因素.结论 老年晚期肺癌患者初诊时NLR、PLR和GNRI均对患者预后具有预测价值,联合检测价值更高.

英文摘要:

      Objective To explore the relationship between peripheral blood inflammatory indexes[neutrophil-to-lymphocyte ratio(NLR)and platelet-to-lymphocyte ratio(PLR)],nutritional risk index(NRI)and prognosis in elderly patients with diagnosed advanced lung cancer at the initial diagnosis.Methods A total of 242 elderly patients with advanced lung cancer admitted to the hospital between February 2021 and June 2023 were enrolled as the research subjects.The levels of NLR,PLR,and NRI were observed in patients with different differentiation grades and lymph node metastasis status.The survival analysis was performed by Kaplan-Meier survival curves.The predictive value of NLR,PLR,NRI and their combined detection for prognosis(progression-free survival,PFS)was analyzed by receiver operating characteristic(ROC)curves.The influencing factors of PFS were analyzed by COX proportional hazards regression analysis.Results Compared with patients with moderate-high differentiated lung cancer,the levels of NLR and PLR were higher in those with low differentiated lung cancer,while NRI level was lower(P＜0.05).Compared with patients without metastasis,the levels of NLR and PLR were higher in those with lymph node metastasis,while NRI level was lower(P＜0.05).The follow-up period ranged from 12 to 42 months.The cumulative overall survival rate and PFS rate were 66.94％(162/242)and 64.05％(155/242),respective-ly.ROC curve analysis showed that the areas under the curve(AUC)of NLR,PLR,NRI and their combined detection for predicting prognosis were 0.761,0.890,0.882 and 0.860,respectively,and the cutoff values of NLR,PLR and NRI were 4.39,221.50 and 96,respectively.Multivariate COX regression analysis showed that lymph node metastasis,NLR≥4.39 and PLR ≥221.50 were all independent risk factors for the prognosis in patients with lung cancer(P＜0.05),while NRI ≥96 was a protective factor.Conclusion NLR PLR and NRI all have value in predicting the prognosis of elderly patients with diagnosed advanced lung cancer at the initial diagnosis,and their combined detection offers higher prognostic value.