Song Ying-Jian, Gao Xin-Huai, Hong Yong-Qing, Wang Li-Xin
Department of Respiratory Medicine, Huai'an First People's Hospital, Nanjing Medical University, Huai'an 223300, Jiangsu, China.
Oncotarget. 2017 Dec 12;9(1):892-900. doi: 10.18632/oncotarget.23184. eCollection 2018 Jan 2.
We investigated the prognostic value of serum bilirubin levels in stage I-II non-small cell lung cancer (NSCLC) patients and evaluated the relationship between bilirubin levels and response to first-line platinum-based chemotherapy. We divided 634 NSCLC patients from a single hospital in China into retrospective training ( = 307) and prospective validation ( = 327) cohorts. X-tile was used to identify the optimal serum bilirubin cutoff value for sorting retrospective cohort patients into low and high overall survival (OS) groups. TNM stage and serum bilirubin levels were associated with OS on univariate analysis. Direct bilirubin (DBIL) levels were correlated with tumor progression and response to first-line platinum-based chemotherapy, and were associated with OS after adjusting for TNM stage. Our findings indicate a DBIL-based prognostic nomogram is more accurate than the TNM staging system in predicting clinical outcomes, and that the DBIL level is an independent predictor of OS in NSCLC. Thus, an index that combines DBIL with TNM stage may better predict patient outcomes than TNM stage alone.
我们研究了血清胆红素水平在Ⅰ-Ⅱ期非小细胞肺癌（NSCLC）患者中的预后价值，并评估了胆红素水平与一线铂类化疗反应之间的关系。我们将来自中国一家医院的634例NSCLC患者分为回顾性训练队列（n = 307）和前瞻性验证队列（n = 327）。使用X-tile软件确定将回顾性队列患者分为总生存期（OS）低分组和高分组的最佳血清胆红素临界值。单因素分析显示，TNM分期和血清胆红素水平与OS相关。直接胆红素（DBIL）水平与肿瘤进展及一线铂类化疗反应相关，在调整TNM分期后与OS相关。我们的研究结果表明，基于DBIL的预后列线图在预测临床结局方面比TNM分期系统更准确，并且DBIL水平是NSCLC患者OS的独立预测因子。因此，将DBIL与TNM分期相结合的指标可能比单独的TNM分期能更好地预测患者预后。
