握力减弱、全身炎症指标与体力状况良好的肺癌患者的总生存：一项大型多中心观察性研究。

Handgrip weakness, systemic inflammation indicators, and overall survival in lung cancer patients with well performance status: A large multicenter observational study.

机构信息

Department of Gastrointestinal Surgery/Clinical Nutrition, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing, China.

National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China.

出版信息

Cancer Med. 2023 Feb;12(3):2818-2830. doi: 10.1002/cam4.5180. Epub 2022 Sep 8.

DOI:10.1002/cam4.5180

PMID:36073671

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9939150/

Abstract

BACKGROUND

Systemic inflammation and handgrip weakness have been used to predict mortality in many cancers. The purpose of current study was to evaluate the association of co-occurrence of inflammation indicators and handgrip weakness with overall survival (OS) of lung cancer (LC) patients with good performance status.

METHODS

The cutoff points for handgrip strength (HGS) and the four inflammation indicators were calculated using Maxstat. The time-dependent receiver operating characteristic curve and C-index were used to select optimal inflammation indicator for predicting OS of LC patients. The Cox proportional hazard regression model was used to calculate the hazard ratio (HR) of mortality. Kaplan-Meier curves were constructed to evaluate the association of indicators and the OS of LC patients.

RESULTS

Among the 1951 patients, the mean ± standard deviation (SD) age was 60.6 ± 9.9 years, and 1300 (66.6%) patients were male. In patients with good performance status (PS), handgrip weakness (HR, 1.49; 95% confidence interval [95% CI], 1.30-1.70, p < 0.001) and low advanced lung cancer inflammation index (ALI) (HR, 2.05; 95%CI, 1.79-2.34, p < 0.001), high systemic immune-inflammation index (SII) (HR, 1.91; 95%CI, 1.66-2.19, p < 0.001), high platelet: lymphocyte ratio (PLR) (HR, 1.60; 95%CI, 1.40-1.82, p < 0.001), or high neutrophil: lymphocyte ratio (NLR) (HR, 2.01; 95%CI, 1.76-2.30, p < 0.001) were associated with increased mortality risk of LC patients. ALI had better C-index (0.624) and time-AUC in the prediction of OS in LC patients with good PS than other three combinations. The co-occurrence of handgrip weakness and low ALI more than doubled the risk of death in LC with good PS (HR, 2.44; 95% CI, 2.06-2.89, p < 0.001).

CONCLUSION

In LC patients who have good PS, patients with combined handgrip weakness and low ALI have the worst prognosis.

THE TRIAL REGISTRATION NUMBER

ChiCTR1800020329.

摘要

背景

全身性炎症和握力减弱已被用于预测许多癌症的死亡率。本研究的目的是评估炎症指标和握力减弱同时出现与表现状态良好的肺癌（LC）患者总生存（OS）的关系。

方法

使用 Maxstat 计算握力强度（HGS）和四个炎症指标的截断点。时间依赖性接受者操作特征曲线和 C 指数用于选择预测 LC 患者 OS 的最佳炎症指标。Cox 比例风险回归模型用于计算死亡率的风险比（HR）。Kaplan-Meier 曲线用于评估指标与 LC 患者 OS 的关系。

结果

在 1951 例患者中，平均年龄为 60.6±9.9 岁，1300 例（66.6%）为男性。在表现状态良好（PS）的患者中，握力减弱（HR，1.49；95%置信区间[95%CI]，1.30-1.70，p<0.001）和低高级肺癌炎症指数（ALI）（HR，2.05；95%CI，1.79-2.34，p<0.001），高全身免疫炎症指数（SII）（HR，1.91；95%CI，1.66-2.19，p<0.001），高血小板与淋巴细胞比值（PLR）（HR，1.60；95%CI，1.40-1.82，p<0.001）或高中性粒细胞与淋巴细胞比值（NLR）（HR，2.01；95%CI，1.76-2.30，p<0.001）与 LC 患者死亡率风险增加相关。ALI 在预测表现状态良好的 LC 患者 OS 方面具有更好的 C 指数（0.624）和时间-AUC。在表现状态良好的 LC 患者中，握力减弱和低 ALI 同时出现使死亡风险增加一倍以上（HR，2.44；95%CI，2.06-2.89，p<0.001）。