预后营养指数（PNI）和中性粒细胞与淋巴细胞比值（NLR）对铂类化疗治疗晚期非小细胞肺癌的预后价值。
The prognostic value of prognostic nutritional index (PNI) and neutrophil to lymphocyte ratio (NLR) for advanced non-small cell lung cancer treated with platinum-based chemotherapeutics.
机构信息
Department of Oncology, Cancer Rehabilitation Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China; Department of Oncology, The Fifth People's Hospital of Changshu, Changshu 215500, China.
Department of Oncology, Cancer Rehabilitation Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.
出版信息
Ann Palliat Med. 2020 May;9(3):967-978. doi: 10.21037/apm.2020.04.31. Epub 2020 Apr 21.
BACKGROUND
The present study aimed to investigate the relationship between prognostic nutritional index (PNI) and peripheral blood neutrophil to lymphocyte ratio (NLR), and the prognosis of patients with advanced non-small cell lung cancer (NSCLC) treated with platinum-based therapeutics.
METHODS
The data of 99 advanced NSCLC patients treated with platinum chemotherapeutics between January 2011 and June 2019 were retrospectively analyzed. The association between PNI and NLR and the clinicopathological characteristics of the patients was examined. The patients were randomized into high or low groups according to PNI and NLR. The predictive value of PNI and NLR for overall survival (OS) was evaluated by receiver operating characteristic (ROC) curve analysis. Univariate and multivariate Cox proportional hazards regression analyses were performed to investigate the prognostic factors of advanced NSCLC patients treated with platinum-based chemotherapeutics. The association between PNI and NLR and progression-free survival (PFS) or OS was determined using the Kaplan-Meier method and compared between groups using the log-rank test.
RESULTS
The ROC curve analysis determined the optimal cut-off values of PNI and NLR for predicting OS to be 52.525 and 3.525, respectively. Univariate analysis indicated that low Karnofsky performance scale (KPS) score (P=0.005), poor tumor differentiation (P=0.022), brain metastasis (P<0.001), and low PNI (P=0.001) were independent risk factors for PFS in patients with advanced NSCLC; however, there was no significant correlation observed between NLR (P=0.082) and PFS in patients with advanced NSCLC. Low KPS score (P=0.003), poor tumor differentiation (P=0.001), brain metastasis (P<0.001), low PNI (P<0.001), and high NLR (P=0.046) were significantly associated with shorter OS. Furthermore, Cox multivariate analysis revealed that brain metastasis (P=0.005) and low PNI (P=0.008) were significant independent prognostic factors for PFS, while brain metastasis (P=0.003) and low PNI (P=0.028) were also found to be significant independent risk factors for poor OS.
CONCLUSIONS
PNI is a reliable, simple, easily available, and inexpensive biomarker for predicting the prognosis of advanced NSCLC patients treated with platinum-based chemotherapeutics in routine clinical practice. Furthermore, PNI is superior to NLR in as a prognostic indicator for advanced NSCLC patients treated with platinum-based chemotherapeutics.
背景
本研究旨在探讨预后营养指数（PNI）与外周血中性粒细胞与淋巴细胞比值（NLR）与接受铂类治疗的晚期非小细胞肺癌（NSCLC）患者预后的关系。
方法
回顾性分析 2011 年 1 月至 2019 年 6 月期间 99 例接受铂类化疗的晚期 NSCLC 患者的数据。检查 PNI 和 NLR 与患者临床病理特征之间的关系。根据 PNI 和 NLR 将患者随机分为高或低组。通过接收者操作特征（ROC）曲线分析评估 PNI 和 NLR 对总生存期（OS）的预测价值。使用单因素和多因素 Cox 比例风险回归分析探讨接受铂类化疗的晚期 NSCLC 患者的预后因素。使用 Kaplan-Meier 方法确定 PNI 和 NLR 与无进展生存期（PFS）或 OS 的关系，并使用对数秩检验比较组间差异。
结果
ROC 曲线分析确定预测 OS 的 PNI 和 NLR 的最佳截断值分别为 52.525 和 3.525。单因素分析表明，卡氏功能状态评分（KPS）评分低（P=0.005）、肿瘤分化差（P=0.022）、脑转移（P<0.001）和 PNI 低（P=0.001）是晚期 NSCLC 患者 PFS 的独立危险因素；然而，晚期 NSCLC 患者 NLR 与 PFS 之间无显著相关性（P=0.082）。KPS 评分低（P=0.003）、肿瘤分化差（P=0.001）、脑转移（P<0.001）、PNI 低（P<0.001）和 NLR 高（P=0.046）与 OS 较短显著相关。此外，Cox 多因素分析显示脑转移（P=0.005）和 PNI 低（P=0.008）是 PFS 的显著独立预后因素，而脑转移（P=0.003）和 PNI 低（P=0.028）也是 OS 不良的显著独立危险因素。
结论
PNI 是一种可靠、简单、易于获得且价格低廉的生物标志物，可用于预测接受铂类化疗的晚期 NSCLC 患者的预后。此外，PNI 作为接受铂类化疗的晚期 NSCLC 患者的预后指标优于 NLR。
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