慢性阻塞性肺疾病合并全身炎症状态对晚期 NSCLC 患者预后的影响：多中心回顾性队列研究。
Impact of Combined Chronic Obstructive Pulmonary Disease Status and Systemic Inflammation on Outcome of Advanced NSCLC: Multicenter Retrospective Cohort Study.
机构信息
Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Republic of Korea.
出版信息
Int J Chron Obstruct Pulmon Dis. 2020 Dec 14;15:3323-3334. doi: 10.2147/COPD.S274354. eCollection 2020.
BACKGROUND
In patients with non-small cell lung cancer (NSCLC), both chronic obstructive pulmonary disease (COPD) and systemic inflammatory biomarkers, such as neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR), have significant association with prognosis. NLR and PLR also predict mortality in patients with COPD alone. A combination of the two parameters may be helpful in a more individualized approach for predicting prognosis in NSCLC.
METHODS
Medical records of patients with stage IIIB and IV NSCLC from January 2012 to January 2018 in seven university hospitals were reviewed. Patients were categorized into four subgroups based on pulmonary function test results and cutoffs for NLR or PLR.
RESULTS
A total of 277 patients were evaluated and categorized into non-COPD and COPD groups; 194 patients were in the non-COPD group and 83 patients were in the COPD group. The non-COPD group showed significantly longer overall survival (OS) compared with the COPD group (P = 0.019). Median survival was significantly different between high/low PLR groups (P < 0.001), between high/low NLR groups (P = 0.001), and between high/low c-reactive protein (CRP) groups (P < 0.001). PLR, NLR and CRP showed significant correlations with each other. PLR showed a significant negative linear correlation with FVC (absolute) (r = -0.149, P = 0.015), FVC (%) (r = -0.192, P = 0.002), DLCO (absolute) (r = -0.271, P < 0.001), DLCO (%) (r = -0.139, P = 0.032), and NLR (r = 0.718, P < 0.001). In the multivariate analysis, the high PLR, COPD sub-group showed significantly higher risk for mortality (HR 2.066 (1.175-3.633), P = 0.012) compared with the low-PLR non-COPD group. However, COPD-NLR subtype was not an independent predictor for OS.
CONCLUSION
A combination of COPD status and PLR may be a cost-effective and readily available prognostic marker in patients with advanced NSCLC.
背景
在非小细胞肺癌（NSCLC）患者中，慢性阻塞性肺疾病（COPD）和全身炎症生物标志物，如中性粒细胞-淋巴细胞比值（NLR）和血小板-淋巴细胞比值（PLR），均与预后有显著关联。NLR 和 PLR 也可预测 COPD 患者的死亡率。联合这两个参数可能有助于更个体化地预测 NSCLC 的预后。
方法
回顾 2012 年 1 月至 2018 年 1 月七所大学医院 3B 期和 4 期 NSCLC 患者的病历。根据肺功能检查结果和 NLR 或 PLR 的截断值，将患者分为四组。
结果
共评估了 277 例患者，分为非 COPD 和 COPD 组；194 例患者为非 COPD 组，83 例患者为 COPD 组。非 COPD 组的总生存期（OS）明显长于 COPD 组（P = 0.019）。高/低 PLR 组（P < 0.001）、高/低 NLR 组（P = 0.001）和高/低 C 反应蛋白（CRP）组（P < 0.001）之间的中位生存时间差异显著。PLR、NLR 和 CRP 之间存在显著的相关性。PLR 与 FVC（绝对值）（r = -0.149，P = 0.015）、FVC（%）（r = -0.192，P = 0.002）、DLCO（绝对值）（r = -0.271，P < 0.001）、DLCO（%）（r = -0.139，P = 0.032）呈显著负线性相关，NLR（r = 0.718，P < 0.001）。多变量分析显示，高 PLR、COPD 亚组的死亡率显著高于低 PLR 非 COPD 组（HR 2.066（1.175-3.633），P = 0.012）。然而，COPD-NLR 亚型不是 OS 的独立预测因子。
结论
COPD 状态和 PLR 的联合可能是晚期 NSCLC 患者一种具有成本效益且易于获得的预后标志物。
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