Gan Yuncui, Ren Jing, Xian Jinghong, Yu He, Jin Jing, Li Dan, Li Weimin
Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
Integrated Care Management Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
Int J Gen Med. 2022 Mar 29;15:3405-3416. doi: 10.2147/IJGM.S348912. eCollection 2022.
Resistance inevitably develops in epidermal growth factor receptor (EGFR)-mutated advanced non-small-cell lung cancer (NSCLC) patients after treatment of EGFR tyrosine kinase inhibitors (EGFR-TKIs). The albumin-to-alkaline phosphatase ratio (AAPR), a novel index, has been reported to be associated with survival in various cancers. In this study, we explored the prognostic value of AAPR in -mutated advanced NSCLC patients treated with first-line EGFR-TKIs.
The clinical and pretreatment laboratory data were retrospectively extracted from hospital medical system. The Log-rank and Kaplan-Meier analyses were adopted to detect differences in survival between groups. Univariate and multivariate Cox's proportional hazard regression models were applied to assess the prognostic value of AAPR for progression-free survival (PFS) and overall survival (OS).
Totally, 598 -mutated NSCLC patients with stage IIIB-IV were enrolled into this study. The median age of all patients was 60 years, and 56.9% were women. About 97% patients had common EGFR gene mutations of deletions in exon 19 (19 del) or a point mutation in exon 21 (L858R). Using receiver operating characteristic (ROC) curve analysis and the Youden index, the optimal cut-off value of pretreatment AAPR was 0.47. Patients with high AAPR achieved longer median PFS and OS than patients with low AAPR (14.0 months vs 10.4 months, <0.01; 58.2 months vs 36.7 months, <0.001, respectively). The multivariate analysis by Cox's proportional hazards regression model demonstrated that AAPR was an independent prognostic factor for both PFS (HR: 0.813, 95% CI: 0.673-0.984, =0.033) and OS (HR: 0.629, 95% CI: 0.476-0.830, =0.001).
Pretreatment AAPR, measured as part of routine blood biochemical test, may be a reliable prognostic indicator in -mutated advanced NSCLC patients treated with first-line first-generation EGFR-TKIs.
表皮生长因子受体（EGFR）突变的晚期非小细胞肺癌（NSCLC）患者在接受EGFR酪氨酸激酶抑制剂（EGFR-TKIs）治疗后不可避免地会产生耐药性。白蛋白与碱性磷酸酶比值（AAPR）作为一项新指标，已被报道与多种癌症的生存率相关。在本研究中，我们探讨了AAPR在接受一线EGFR-TKIs治疗的EGFR突变晚期NSCLC患者中的预后价值。
从医院医疗系统中回顾性提取临床和治疗前实验室数据。采用Log-rank检验和Kaplan-Meier分析来检测组间生存率的差异。应用单因素和多因素Cox比例风险回归模型评估AAPR对无进展生存期（PFS）和总生存期（OS）的预后价值。
本研究共纳入598例ⅢB-IV期EGFR突变的NSCLC患者。所有患者的中位年龄为60岁，女性占56.9%。约97%的患者有常见的EGFR基因突变，即外显子19缺失（19 del）或外显子21点突变（L858R）。通过受试者工作特征（ROC）曲线分析和尤登指数，治疗前AAPR的最佳截断值为0.47。AAPR高的患者比AAPR低的患者获得更长的中位PFS和OS（分别为14.0个月对10.4个月，P<0.01；58.2个月对36.7个月，P<0.001）。Cox比例风险回归模型的多因素分析表明，AAPR是PFS（HR：0.813，95%CI：0.673-0.984，P=0.033）和OS（HR：0.629，95%CI：0.476-0.830，P=0.001）的独立预后因素。
作为常规血液生化检查一部分所测得的治疗前AAPR，可能是接受一线第一代EGFR-TKIs治疗的EGFR突变晚期NSCLC患者的可靠预后指标。
