淋巴细胞与 C 反应蛋白比值与 GLIM 定义的营养不良癌症患者生存结局的相关性：一项多中心研究。

Association between the Lymphocyte-to-C-Reactive Protein Ratio and Survival Outcomes in Cancer Patients with GLIM-Defined Malnutrition: A Multicenter Study.

机构信息

Dr Han-Ping Shi, Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; Tel: +86-10-6392 6985; Fax: +86-10 -6392 6325. E-mail:

出版信息

J Nutr Health Aging. 2022;26(9):847-855. doi: 10.1007/s12603-022-1835-3.

DOI:10.1007/s12603-022-1835-3

PMID:36156676

Abstract

BACKGROUND AND AIMS

This study assessed the prognostic value of LCR in patients with cancer-associated malnutrition (CAM). Systemic inflammatory markers, particularly the lymphocyte-to-C-reactive protein ratio (LCR), are related to the survival of patients with CAM. The present retrospective analysis based on a prospective multicenter cohort study, which involved 1,437 hospitalized patients with CAM.

METHODS

The area under the receiver operating characteristic curve (AUC) of ten inflammatory indicators-LCR, advanced lung cancer inflammation index, neutrophil-to-lymphocyte ratio, prognostic nutritional index, modified Glasgow prognostic score, systemic immune-inflammation index, albumin-to-globulin ratio, LCR score, glucose-to-lymphocyte ratio, and platelet-to-lymphocyte ratio-were constructed. Nutritional status, blood markers, and quality of life (QoL) were evaluated within 48 h of admission. The overall survival (OS) was evaluated from September 1 to December 29, 2021.

RESULTS

A total of 1,431 cancer patients diagnosed with malnutrition based on the Global Leadership Initiative on Malnutrition (GLIM) criteria. Male patients were 62.8% of all, and the mean age was 60.66 years old. The AUC of LCR was higher than that of other inflammatory markers. The restricted cubic spline (RCS) of the Hazard ratios (HRs) showed an inverse L-shaped relationship with LCR. In addition, patients with low LCR had significantly poorer OS than those with high LCR. The addition of LCR to the model increased the predictive ability of 1-year mortality (AUC increase of 0.036), 3-year mortality (AUC increase of 0.038), and 5-year mortality (AUC increase of 0.031).

CONCLUSIONS

Assessing the LCR can help the medical staff identify cancer patients with nutritional deficiency at high risk of oncological outcomes and develop individualized therapeutic strategies.

摘要

背景与目的

本研究评估了淋巴细胞与 C 反应蛋白比值（LCR）在癌症相关性营养不良（CAM）患者中的预后价值。系统性炎症标志物，特别是淋巴细胞与 C 反应蛋白比值（LCR），与 CAM 患者的生存相关。本回顾性分析基于一项前瞻性多中心队列研究，该研究纳入了 1437 例住院 CAM 患者。

方法

构建了十个炎症指标的受试者工作特征曲线（ROC）下面积（AUC），包括 LCR、晚期肺癌炎症指数、中性粒细胞与淋巴细胞比值、预后营养指数、改良格拉斯哥预后评分、全身免疫炎症指数、白蛋白与球蛋白比值、LCR 评分、葡萄糖与淋巴细胞比值和血小板与淋巴细胞比值。在入院后 48 小时内评估营养状况、血液标志物和生活质量（QoL）。总体生存期（OS）从 2021 年 9 月 1 日至 12 月 29 日进行评估。

结果

共有 1431 例癌症患者根据全球营养倡议（GLIM）标准诊断为营养不良。男性患者占所有患者的 62.8%，平均年龄为 60.66 岁。LCR 的 AUC 高于其他炎症标志物。风险比（HR）的限制立方样条（RCS）显示与 LCR 呈反向 L 形关系。此外，低 LCR 患者的 OS 明显差于高 LCR 患者。将 LCR 添加到模型中增加了 1 年死亡率（AUC 增加 0.036）、3 年死亡率（AUC 增加 0.038）和 5 年死亡率（AUC 增加 0.031）的预测能力。