Zhang Tiantian, Liu Wei, Xu Chunhua
Department of Respiratory Medicine, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu, China.
Clinical Center of Nanjing Respiratory Diseases and Imaging, Nanjing Chest Hospital, Nanjing, Jiangsu, China.
Front Oncol. 2023 Sep 7;13:1166802. doi: 10.3389/fonc.2023.1166802. eCollection 2023.
To investigate the effect of hemoglobin, albumin, lymphocytes, platelet (HALP) score and platelet to albumin ratio (PAR) on prognosis of patients with lung adenosquamous carcinoma (ASC) after surgery.
A total of 52 patients diagnosed with ASC after surgical resection were collected from Nanjing Chest Hospital from 2012 to 2021, and their general clinical data, pathological data and laboratory indexes were collected. The changes of Alb and Plt levels before and after surgery, HALP scores (hemoglobin albumin lymphocytes/platelets), and postoperative PAR, PLR, NLR were retrospectively analyzed, and their influence on the prognosis of patients with ASC was investigated. The cut-off value of △Alb, △Plt, postoperative PAR, PLR and NLR were determined by the receiver operating characteristic (ROC) curve, the optimal cut-off value of HALP score before and after surgery was calculated by using X-tile software, and the clinicopathological characteristics were compared between the high PAR and low PAR groups and between high HALP score and low HALP score group to analyze the factors influencing the prognosis of patients with ASC. Univariate and multivariate Cox proportional regression analyses were used to assess independent risk factors affecting overall survival (OS) and disease-free survival (DFS) in patients with ASC. Kaplan-Meier method was used to evaluate the correlation between OS, DFS and PAR and HALP score.
A critical value of PAR was 7.40×10^9 and an area under the curve (AUC) of 0.737 (95%CI: 0.597-0.876, = 0.004). The best cut-off value of the preoperative HALP score was 24.3. Univariate Cox analysis showed that the cut margin ( = 0.013), the degree of differentiation ( = 0.021), N stage ( = 0.049), △Plt ( = 0.010), △Alb ( = 0.016), PAR ( = 0.003), NLR ( = 0.025), PLR ( = 0.029), preoperative HALP score ( = 0.000) and post-operative HALP score ( = 0.010) were all associated with postoperative OS in ASC patients. Cut margin ( = 0.029), the degree of differentiation ( = 0.045), maximum tumor diameter ( = 0.018), N stage ( = 0.035), △Plt ( = 0.007), △Alb ( = 0.007), PAR ( = 0.004), NLR ( = 0.041), PLR ( = 0.030), preoperative HALP score ( = 0.000), and postoperative HALP score ( = 0.011) were related to postoperative DFS in ASC patients. Multivariate analysis revealed that PAR (HR: 6.877, 95%CI: 1.817-26.038, = 0.005), differentiation degree (HR: 0.059, 95%CI: 0.006-0.591, = 0.016) and preoperative HALP score (HR: 0.224, 95%CI: 0.068-0.733, = 0.013) had significant effect on OS. Tumor maximum diameter (HR: 3.442, 95%CI: 1.148-10.318, = 0.027) and preoperative HALP score (HR: 0.268, 95%CI: 0.085-0.847, = 0.025) had significant influence on DFS.
PAR and preoperative HALP score were potentially useful biomarkers for evaluating the outcome of patients with postoperative ASC. PAR, the degree of differentiation and preoperative HALP score were independent prognostic factors for postoperative OS in ASC patients. Maximum tumor diameter and preoperative HALP score were independent prognostic factors for postoperative DFS in ASC patients.
探讨血红蛋白、白蛋白、淋巴细胞、血小板（HALP）评分及血小板与白蛋白比值（PAR）对肺腺鳞癌（ASC）患者术后预后的影响。
收集2012年至2021年在南京胸科医院手术切除后诊断为ASC的52例患者，收集其一般临床资料、病理资料及实验室指标。回顾性分析手术前后白蛋白（Alb）和血小板（Plt）水平变化、HALP评分（血红蛋白×白蛋白×淋巴细胞/血小板）以及术后PAR、血小板与淋巴细胞比值（PLR）、中性粒细胞与淋巴细胞比值（NLR），并研究它们对ASC患者预后的影响。通过受试者工作特征（ROC）曲线确定△Alb、△Plt、术后PAR、PLR和NLR的截断值，使用X-tile软件计算术前和术后HALP评分的最佳截断值，比较高PAR组与低PAR组以及高HALP评分组与低HALP评分组之间的临床病理特征，以分析影响ASC患者预后的因素。采用单因素和多因素Cox比例回归分析评估影响ASC患者总生存（OS）和无病生存（DFS）的独立危险因素。采用Kaplan-Meier法评估OS、DFS与PAR及HALP评分之间的相关性。
PAR的临界值为7.40×10^9，曲线下面积（AUC）为0.737（95%CI：0.597 - 0.876，P = 0.004）。术前HALP评分的最佳截断值为24.3。单因素Cox分析显示，切缘（P = 0.013）\t、分化程度（P = 0.021）\t、N分期（P = 0.049）\t、△Plt（P = 0.010）\t\t、△Alb（P = 0.016）\t、PAR（P = 0.003）\t、NLR（P = 0.025）\t、PLR（P = 0.029）\t、术前HALP评分（P = 0.000）和术后HALP评分（P = 0.010）均与ASC患者术后OS相关。切缘（P = 0.029）\t、分化程度（P = 0.0\t45） \t、最大肿瘤直径（P = 0.018）\t、N分期（P = 0.035）\t、△Plt（P = 0.007）\t、△Alb（P = 0.007）\t、PAR（P = 0.004）\t、NLR（P = 0.041）\t、PLR（P = 0.030）\t、术前HALP评分（P = 0.000）和术后HALP评分（P = ０.011）与ASC患者术后DFS相关。多因素分析显示，PAR（HR：6.877，95%CI：1.817 - 26.038，P = 0.005）、分化程度（HR：0.059，95%CI：0.006 - 0.591，P = 0.016）和术前HALP评分（HR：0.224，95%CI：0.068 - 0.733，P = 0.013）对OS有显著影响。肿瘤最大直径（HR：3.442，95%CI：1.148 - 10.318，P = 0.027）和术前HALP评分（HR：0.268，95%CI：0.085 - 0.847，P = 0.025）对DFS有显著影响。
PAR和术前HALP评分可能是评估ASC患者术后结局的有用生物标志物。PAR、分化程度和术前HALP评分是ASC患者术后OS的独立预后因素。肿瘤最大直径和术前HALP评分是ASC患者术后DFS的独立预后因素。
