Mitsuyoshi Takamasa, Matsuo Yukinori, Itou Hitoshi, Shintani Takashi, Iizuka Yusuke, Kim Young Hak, Mizowaki Takashi
Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Department of Radiation Oncology, Kyoto-Katsura Hospital, Kyoto, Japan.
J Radiat Res. 2018 Jan 1;59(1):50-57. doi: 10.1093/jrr/rrx060.
Systemic inflammation and poor nutritional status have a negative effect on the outcomes of cancer. Here, we analyzed the effects of the pretreatment inflammatory and nutritional status on clinical outcomes of locally advanced non-small-cell lung cancer (NSCLC) patients treated with chemoradiotherapy. We retrospectively reviewed 89 patients with locally advanced NSCLC treated with chemoradiotherapy between July 2006 and June 2013. Serum C-reactive protein (CRP) was assessed as an inflammatory marker, and serum albumin, body mass index (BMI) and skeletal mass index were assessed as nutritional status markers. The relationships between these markers and overall survival (OS) were assessed. The median OS was 24.6 months [95% confidence interval (CI): 19.4-39.3 months]. During follow-up, 58 patients (65%) had disease recurrence and 52 patients (58%) died. In multivariate Cox hazard analysis, CRP levels and BMI approached but did not achieve a significant association with OS (P = 0.062 and 0.094, respectively). Recursive partitioning analysis identified three prognostic groups based on hazard similarity (CRP-BMI scores): 0 = CRP < 0.3 mg/dl, 1 = CRP ≥ 0.3 mg/dl and BMI ≥ 18.5 kg/m2, and 2 = CRP ≥ 0.3 mg/dl and BMI < 18.5 kg/m2. The CRP-BMI score was significantly associated with OS (P = 0.023). Patients with scores of 0, 1 and 2 had median OS of 39.3, 24.5 and 14.5 months, respectively, and the scores also predicted the probability of receiving salvage treatment after recurrence. The CRP-BMI score is thus a simple and useful prognostic marker of clinical outcome for patients with locally advanced NSCLC treated with chemoradiotherapy.
全身炎症反应和营养不良状态对癌症治疗结果具有负面影响。在此，我们分析了局部晚期非小细胞肺癌（NSCLC）患者在接受放化疗前的炎症和营养状态对临床结局的影响。我们回顾性分析了2006年7月至2013年6月期间89例接受放化疗的局部晚期NSCLC患者。血清C反应蛋白（CRP）作为炎症标志物进行评估，血清白蛋白、体重指数（BMI）和骨骼肌质量指数作为营养状态标志物进行评估。评估了这些标志物与总生存期（OS）之间的关系。中位OS为24.6个月[95%置信区间（CI）：19.4 - 39.3个月]。随访期间，58例患者（65%）出现疾病复发，52例患者（58%）死亡。在多因素Cox风险分析中，CRP水平和BMI接近但未达到与OS的显著关联（P分别为0.062和0.094）。递归划分分析根据风险相似性（CRP - BMI评分）确定了三个预后组：0 = CRP < 0.3 mg/dl，1 = CRP≥0.3 mg/dl且BMI≥18.5 kg/m²，2 = CRP≥0.3 mg/dl且BMI < 18.5 kg/m²。CRP - BMI评分与OS显著相关（P = 0.023）。评分分别为0、1和2的患者中位OS分别为39.3、24.5和14.5个月，且这些评分还可预测复发后接受挽救治疗的概率。因此，CRP - BMI评分是接受放化疗的局部晚期NSCLC患者临床结局的一个简单且有用的预后标志物。
