非小细胞肺癌患者免疫炎症指标及营养风险指数与预后的相关性
Correlation of immune inflammatory indices and nutritional risk index with prognosis in patients with non-small cell lung cancer.
作者信息
Shi Zhongmiao, Zheng Dawei, Tang Xiaowan, Du Youyi
机构信息
Department of Cardio-Thoracic Surgery, Shaoxing Shangyu Hospital of Traditional Chinese Medicine Shaoxing 312300, Zhejiang, China.
Department of Respiratory, Nanyang Central Hospital Nanyang 473000, Henan, China.
出版信息
Am J Transl Res. 2023 Jun 15;15(6):4100-4109. eCollection 2023.
OBJECTIVE
To investigate the relationship of lymphocyte-to-monocyte ratio (LMR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and nutritional risk index (NRI) with the prognosis of non-small cell lung cancer (NSCLC).
METHODS
The clinical data of 400 NSCLC patients undergoing surgery at Shaoxing Shangyu Hospital of Traditional Chinese Medicine from January 2019 to June 2022 were collected for this retrospective analysis. The optimal cutoff values for NLR, PLR, LMR and NRI were determined using receiver operating characteristic (ROC) curves. The patients were grouped according to the optimal cutoff values, and the clinicopathological characteristics were compared between groups. The Kaplan-Meier survival curve and Cox risk model were used to identify the independent risk factors affecting the prognosis of patients with NSCLC. A nomogram risk prediction model was constructed and its effectiveness was verified.
RESULTS
ROC curve analysis revealed that the area under the curve (AUC) values for NLR, PLR, LMR and NRI in predicting overall survival of NSCLC patients were 0.827, 0.753, 0.719 and 0.770, respectively. The optimal cutoff values for NLR, PLR, LMR and NRI were 2.49, 126.32, 3.02 and 89, respectively. Survival analysis found that the survival time was shorter in patients with NLR>2.49, PLR>126.32, LMR>3.02 and NRI≤89. Results from Cox model indicated that TNM staging, NLR>2.49, LMR>3.02, NRI≤89, surgical method, intraoperative blood loss, postoperative complication, and adjuvant chemotherapy were risk factors affecting the prognosis of NSCLC patients. A nomogram was constructed based on the results of multivariate analysis. The AUC of the nomogram was 0.967 (95% CI: 0.943-0.992) and 0.948 (95% CI: 0.874-1) in the training set and the test set, respectively. The C-index was 0.90 and 0.89, respectively. The calibration curve demonstrated good agreement between the predicted values of the nomogram and the actual observed values.
CONCLUSION
NLR, LMR and NRI are significant predictors of the prognosis of patients with NSCLC. NLR>2.49, LMR>3.02, and NRI≤89 are risk factors for the prognosis of NSCLC patients.
目的
探讨淋巴细胞与单核细胞比值（LMR）、中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）及营养风险指数（NRI）与非小细胞肺癌（NSCLC）预后的关系。
方法
收集2019年1月至2022年6月在绍兴上虞中医医院接受手术的400例NSCLC患者的临床资料进行回顾性分析。采用受试者工作特征（ROC）曲线确定NLR、PLR、LMR和NRI的最佳截断值。根据最佳截断值对患者进行分组，并比较组间的临床病理特征。采用Kaplan-Meier生存曲线和Cox风险模型确定影响NSCLC患者预后的独立危险因素。构建列线图风险预测模型并验证其有效性。
结果
ROC曲线分析显示，NLR、PLR、LMR和NRI预测NSCLC患者总生存的曲线下面积（AUC）值分别为0.827、0.753、0.719和0.770。NLR、PLR、LMR和NRI的最佳截断值分别为2.49、126.32、3.02和89。生存分析发现，NLR>2.49、PLR>126.32、LMR>3.02和NRI≤89的患者生存时间较短。Cox模型结果表明，TNM分期、NLR>2.49、LMR>3.02、NRI≤89、手术方式、术中出血量、术后并发症及辅助化疗是影响NSCLC患者预后的危险因素。根据多因素分析结果构建列线图。列线图在训练集和测试集的AUC分别为0.967（95%CI：0.943-0.992）和0.948（95%CI：0.874-1）。C指数分别为0.90和0.89。校准曲线显示列线图预测值与实际观察值之间具有良好的一致性。
结论
NLR、LMR和NRI是NSCLC患者预后的重要预测指标。NLR>2.49、LMR>3.02和NRI≤89是NSCLC患者预后的危险因素。
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