Ma Shixin, Wang Lunqing
Graduate School, Dalian Medical University, Dalian, Liaoning, China.
Department of Thoracic Surgery, Qingdao Municipal Hospital, Qingdao, Shandong, China.
Front Oncol. 2024 Jun 24;14:1396843. doi: 10.3389/fonc.2024.1396843. eCollection 2024.
The inflammatory response and the nutritional status are associated with overall survival (OS) in patients with non-small cell lung cancer (NSCLC), but it is unclear which biomarkers are better suited to predict prognosis. This study sought to determine which of the commonly existing inflammatory and nutritional indicators best predicted the OS.
This study included 15 compound indicators based on inflammation or nutrition, with cutoff points obtained through the receiver operating characteristic (ROC) curve. Univariate and multivariate Cox proportional risk models were used to evaluate the relationship between these predictors and OS. Kaplan-Meier curves were used for survival analysis, and log-rank tests were used to compare differences between groups. The C-index was calculated to evaluate the predictive ability of the different indicators.
The study included 899 patients with NSCLC. In the univariate analysis, all 15 measures were significantly associated with the OS of patients (all < 0.05). The results of the C-index analysis showed that the fibrinogen-to-albumin ratio (FAR), the systemic immune-inflammation index (SII), and the albumin-to-alkaline phosphatase ratio (AAPR) were the three indices with the best predictive performance. Among them, FAR (C-index = 0.639) had the best predictive power for OS in patients with NSCLC. In the different subgroups, FAR had the highest C-index in male, non-smoking, adenocarcinoma, and stage II patients. The C-index of the platelet-to-lymphocyte ratio (PLR) in female patients was the highest. SII was the highest in smokers, in those aged <65 and ≥65 years, and in stage III patients. The C-index of AAPR was the highest in non-adenocarcinomas. The C-index of the pan-immune-inflammation value (PIV) was the highest in stage I patients. In the multivariate Cox regression analysis, among FAR, SII, and AAPR, only FAR was an independent predictor of OS in patients with NSCLC. A high FAR was associated with a higher risk of death in patients with NSCLC (HR = 1.601, 95% CI = 1.028-2.495). In order to further evaluate the potential prognostic value of FAR, SII, and AAPR in patients with different stages, Cox regression analysis was performed for those with stage I-II and stage III NSCLC. The results showed that FAR was an independent prognostic factor for OS in patients with stage I-II NSCLC.
For all patients with NSCLC, the prognostic power of FAR was superior to that of other inflammatory and nutritional indicators.
炎症反应和营养状况与非小细胞肺癌（NSCLC）患者的总生存期（OS）相关，但尚不清楚哪些生物标志物更适合预测预后。本研究旨在确定现有的常见炎症和营养指标中哪些能最佳预测OS。
本研究纳入了15个基于炎症或营养的复合指标，通过受试者工作特征（ROC）曲线获得截断点。采用单因素和多因素Cox比例风险模型评估这些预测指标与OS之间的关系。采用Kaplan-Meier曲线进行生存分析，采用对数秩检验比较组间差异。计算C指数以评估不同指标的预测能力。
本研究纳入了899例NSCLC患者。在单因素分析中，所有15项指标均与患者的OS显著相关（均P<0.05）。C指数分析结果显示，纤维蛋白原与白蛋白比值（FAR）、全身免疫炎症指数（SII）和白蛋白与碱性磷酸酶比值（AAPR）是预测性能最佳的三项指标。其中，FAR（C指数=0.639）对NSCLC患者的OS预测能力最佳。在不同亚组中，FAR在男性、非吸烟、腺癌和II期患者中C指数最高。女性患者中血小板与淋巴细胞比值（PLR）的C指数最高。SII在吸烟者、年龄<65岁和≥65岁者以及III期患者中最高。AAPR的C指数在非腺癌中最高。泛免疫炎症值（PIV）的C指数在I期患者中最高。在多因素Cox回归分析中，在FAR、SII和AAPR中，只有FAR是NSCLC患者OS的独立预测因素。高FAR与NSCLC患者较高的死亡风险相关（HR=1.601，95%CI=1.028-2.495）。为了进一步评估FAR、SII和AAPR在不同分期患者中的潜在预后价值，对I-II期和III期NSCLC患者进行了Cox回归分析。结果显示，FAR是I-II期NSCLC患者OS的独立预后因素。
对于所有NSCLC患者，FAR的预后预测能力优于其他炎症和营养指标。
