Lee Sookyung, Eo Wankyu, Jeon Hyeonjin, Park Sora, Chae Jean
Depart of Clinical Oncology, College of Korean Medicine, Kyung Hee University.
Depart of Medical Oncology and Hematology, College of Medicine, Kyung Hee University.
J Cancer. 2017 Aug 25;8(15):2974-2983. doi: 10.7150/jca.20866. eCollection 2017.
This study identified host-related prognostic biomarkers for survival in patients with advanced non-small cell lung cancer (NSCLC).
This study was based on the retrospective review of the medical records of 135 patients with pathologically confirmed advanced NSCLC. The host-related biomarkers assessed in this study that reflected patient condition included hemoglobin (Hb) levels; platelet (PLT), neutrophil, lymphocyte, and monocyte counts; and ferritin concentrations. The overall survival (OS) was calculated by Kaplan-Meier analysis and compared using log-rank tests. Univariate and multivariate analyses of Cox proportional hazards regression were used to evaluate the prognostic impact for survival.
Of the enrolled patients, 91.1% had stage IV NSCLC, 42.2% had ECOG-PS scores of 2, and 57% had undergone multiple rounds of prior systemic therapy. The prognostic factors included low Hb concentration (men: Hb < 13 g/dL, women: Hb < 12 g/dL; 0.046), increased neutrophil count (> 7,700 cells/μL; < 0.001), decreased lymphocyte count (≤ 1500 cells/μL; = 0.011), increased monocyte count (> 800 cells/μL; 0.001), and high ferritin level (men: > 200 ng/mL, women: > 150 ng/mL; 0.001), which were associated with poor OS and increased hazard of mortality. The multivariate proportional hazards model revealed that lymphocyte count, monocyte count, and ferritin level were independent host-related prognostic biomarkers for survival. Increased monocyte count (HR, 3.15; 95% CI, 1.64-6.04; 0.001) and high ferritin level (HR, 1.81; 95% CI, 1.24-2.64; 0.002) were significantly associated with poor survival, whereas increased lymphocyte count (HR, 0.57; 95% CI, 0.40-0.83; 0.004) showed prolonged survival.
Immune factors, such as lymphocyte and monocyte counts, as well as serum ferritin levels, are significant host-related prognostic biomarkers for survival with direct relevance to survival time in patients with advanced NSCLC.
本研究确定了晚期非小细胞肺癌（NSCLC）患者生存的宿主相关预后生物标志物。
本研究基于对135例经病理证实的晚期NSCLC患者病历的回顾性分析。本研究中评估的反映患者状况的宿主相关生物标志物包括血红蛋白（Hb）水平；血小板（PLT）、中性粒细胞、淋巴细胞和单核细胞计数；以及铁蛋白浓度。采用Kaplan-Meier分析计算总生存期（OS），并使用对数秩检验进行比较。采用Cox比例风险回归的单因素和多因素分析来评估生存的预后影响。
在入组患者中，91.1%为IV期NSCLC，42.2%的东部肿瘤协作组（ECOG）体能状态（PS）评分为2，57%接受过多轮先前的全身治疗。预后因素包括低Hb浓度（男性：Hb<13 g/dL，女性：Hb<12 g/dL；P = 0.046）、中性粒细胞计数增加（>7700个细胞/μL；P<0.001）、淋巴细胞计数减少（≤1500个细胞/μL；P = 0.011）、单核细胞计数增加（>800个细胞/μL；P = 0.001）和高铁蛋白水平（男性：>200 ng/mL，女性：>150 ng/mL；P = 0.001），这些与较差的OS和死亡风险增加相关。多因素比例风险模型显示，淋巴细胞计数、单核细胞计数和铁蛋白水平是生存的独立宿主相关预后生物标志物。单核细胞计数增加（风险比[HR]，3.15；95%置信区间[CI]，1.64 - 6.04；P = 0.001）和高铁蛋白水平（HR，1.81；95%CI，1.24 - 2.64；P = 0.002）与较差的生存显著相关，而淋巴细胞计数增加（HR，0.57；95%CI，0.40 - 0.83；P = 0.004）显示生存期延长。
淋巴细胞和单核细胞计数等免疫因素以及血清铁蛋白水平是晚期NSCLC患者生存的重要宿主相关预后生物标志物，与生存时间直接相关。
