Tian Huohuan, Li Guo, Hou Wang, Jin Jing, Wang Chengdi, Ren Pengwei, Wang Haoyu, Wang Jie, Li Weimin, Liu Dan
Department of Respiratory & Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Chinese Academy of Medical Sciences (CAMS) Key Laboratory of Translational Research on Lung Cancer, State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences Peking Union Medical College, Beijing, China.
Front Oncol. 2023 Jul 27;13:1211752. doi: 10.3389/fonc.2023.1211752. eCollection 2023.
Various studies have investigated the predictive significance of numerous peripheral blood biomarkers in patients with small cell lung cancer (SCLC). However, their predictive values have not been validated. This study assessed and evaluated the ability of common nutritional or inflammatory indicators to predict overall survival (OS) in patients with SCLC who received first-line chemotherapy.
Between January 2008 and July 2019, 560 patients with SCLC were enrolled at the Sichuan University West China Hospital. Eleven nutritional or inflammatory indices obtained before chemotherapy were evaluated. The cutoff values of continuous peripheral blood indices were confirmed through maximally selected rank statistics. The relationship of peripheral blood indices with OS was investigated through univariate and multivariate Cox regression analyses. Harrell's concordance (C-index) and time-dependent receiver operating characteristic curve were used to evaluate the performance of these indices.
A total of 560 patients with SCLC were enrolled in the study. All the patients received first-line chemotherapy. In the univariate Cox analysis, all indices, except the Naples score, were related to OS. In the multivariate analysis, albumin-globulin ratio was an independent factor linked with prognosis. All indices exhibited poor performance in OS prediction, with the area under the curve ranging from 0.500 to 0.700. The lactic dehydrogenase (LDH) and prognostic nutritional index (PNI) were comparatively superior predictors with C-index of 0.568 and 0.550, respectively. The LDH showed incremental predictive values, whereas the PNI showed diminishing values as survival time prolonged, especially for men or smokers. The LDH with highest sensitivity (0.646) and advanced lung cancer inflammation index (ALI) with highest specificity (0.952) were conducive to identifying death and survival at different time points.
Common inflammatory or nutritional biomarkers are only marginally useful in predicting outcomes in patients with SCLC receiving first-line chemotherapy. Among them, LDH, PNI, and ALI are relatively promising biomarkers for prognosis evaluation.
多项研究探讨了多种外周血生物标志物在小细胞肺癌（SCLC）患者中的预测意义。然而，它们的预测价值尚未得到验证。本研究评估并评价了常见营养或炎症指标对接受一线化疗的SCLC患者总生存期（OS）的预测能力。
2008年1月至2019年7月，四川大学华西医院纳入了560例SCLC患者。评估了化疗前获得的11项营养或炎症指标。通过最大选择秩统计确定连续外周血指标的临界值。通过单因素和多因素Cox回归分析研究外周血指标与OS的关系。采用Harrell一致性（C指数）和时间依赖性受试者工作特征曲线评估这些指标的性能。
本研究共纳入560例SCLC患者。所有患者均接受一线化疗。在单因素Cox分析中，除那不勒斯评分外，所有指标均与OS相关。在多因素分析中，白蛋白球蛋白比值是与预后相关的独立因素。所有指标在OS预测中的表现均较差，曲线下面积在0.500至0.700之间。乳酸脱氢酶（LDH）和预后营养指数（PNI）是相对较好的预测指标，C指数分别为0.568和0.550。随着生存时间延长，LDH的预测价值增加，而PNI的预测价值降低，尤其是男性或吸烟者。敏感性最高的LDH（0.646）和特异性最高的晚期肺癌炎症指数（ALI，0.952）有助于在不同时间点识别死亡和生存情况。
常见的炎症或营养生物标志物在预测接受一线化疗的SCLC患者的预后方面作用有限。其中，LDH、PNI和ALI是相对有前景的预后评估生物标志物。
