基于系统性炎症反应的 I 期肺腺癌预后评估。

Prognostic evaluation of stage I lung adenocarcinoma based on systematic inflammatory response.

机构信息

Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, China.

Shanghai Pulmonary Hospital, School of Medicine, Tongji University, China.

出版信息

JNCI Cancer Spectr. 2023 Oct 31;7(6). doi: 10.1093/jncics/pkad090.

DOI:10.1093/jncics/pkad090

PMID:37941434

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10660118/

Abstract

BACKGROUND

This study aimed to construct an effective nomogram based on the clinical and laboratory characteristics to predict the prognosis of stage I lung adenocarcinoma with EGFR alteration.

METHODS

A retrospective study was performed of 913 eligible patients with EGFR alteration after surgery at Shanghai Pulmonary Hospital. The peripheral blood indicators were included in the nomogram. Calibration plots, concordance index, decision curve analysis, and X-tile software were used in this study. Recurrence-free survival (RFS) and overall survival were estimated by the Kaplan-Meier method and compared using the log-rank test.

RESULTS

Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio were independent risk factors for RFS. The calibration curves for RFS probabilities showed good agreement between the nomogram prediction and actual observation. Furthermore, the nomogram, including neutrophil to lymphocyte ratio and platelet to lymphocyte ratio had a higher concordance index (0.732, 95% confidence interval = 0.706 to 0.758) than that without neutrophil to lymphocyte ratio or platelet to lymphocyte ratio (0.713, 95% confidence interval = 0.686 to 0.740), and decision curve analysis plots showed that the nomogram with neutrophil to lymphocyte ratio and platelet to lymphocyte ratio had better clinical practicability. Additionally, the patients were divided into 2 groups according to cutoff values of risk points, and statistically significant differences in RFS and overall survival were observed between the high-risk and low-risk groups (P < .001).

CONCLUSIONS

High pretreatment levels of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio were strongly associated with a worse prognosis in stage I EGFR-altered lung adenocarcinomas. Besides, the proposed nomogram with neutrophil to lymphocyte ratio and platelet to lymphocyte ratio presented a better prediction ability for the survival of those patients.

摘要

背景

本研究旨在构建一个基于临床和实验室特征的有效列线图，以预测 EGFR 改变的 I 期肺腺癌患者的预后。

方法

对上海肺科医院手术后 EGFR 改变的 913 例合格患者进行回顾性研究。该列线图纳入外周血指标。本研究采用校准图、一致性指数、决策曲线分析和 X-tile 软件。采用 Kaplan-Meier 法估计无复发生存率（RFS）和总生存率，并采用对数秩检验进行比较。

结果

中性粒细胞与淋巴细胞比值和血小板与淋巴细胞比值是 RFS 的独立危险因素。RFS 概率的校准曲线显示，列线图预测与实际观察结果具有良好的一致性。此外，包括中性粒细胞与淋巴细胞比值和血小板与淋巴细胞比值的列线图的一致性指数（0.732，95%置信区间=0.706 至 0.758）高于不包括中性粒细胞与淋巴细胞比值或血小板与淋巴细胞比值的列线图（0.713，95%置信区间=0.686 至 0.740），决策曲线分析图表明，包含中性粒细胞与淋巴细胞比值和血小板与淋巴细胞比值的列线图具有更好的临床实用性。此外，根据风险点的截断值将患者分为 2 组，高风险组和低风险组的 RFS 和总生存率存在统计学差异（P<0.001）。