中性粒细胞与白蛋白比值（NPAR）与癌症患者死亡率之间的关联：来自美国国家健康与营养检查调查的见解
The Association Between Neutrophil-Percentage-to-Albumin Ratio (NPAR) and Mortality Among Individuals With Cancer: Insights From National Health and Nutrition Examination Survey.
作者信息
Li Xinyang, Wu Meng, Chen Minxin, Liu Rufei, Tao Qingxu, Hu Yun, Yu Jinming, Chen Dawei
机构信息
Shandong Provincial Key Laboratory of Precision Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China.
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
出版信息
Cancer Med. 2025 Jan;14(2):e70527. doi: 10.1002/cam4.70527.
BACKGROUND
Neutrophils interact with tumor cells, potentially exacerbating cancer progression. Additionally, decreased albumin levels are a marker of poor cancer prognosis. The neutrophil-percentage-to-albumin ratio (NPAR) has been used for prognostic assessment in non-cancerous diseases, but its relationship with mortality risk in cancer patients has not been explored. Therefore, we utilized data from the National Health and Nutrition Examination Survey (NHANES) to investigate the correlation between NPAR and the risks of all-cause mortality and cancer-related mortality among cancer patients.
METHODS
This study leveraged comprehensive NHANES data spanning 2005-2016. We analyzed the relationship between NPAR and the risks of cancer incidence, all-cause mortality, and cancer-related mortality using weighted Logistic and Cox regression models, as well as trend tests. Restricted cubic spline analysis was employed to investigate NPAR's nonlinear relationship with mortality risk. Furthermore, Kaplan-Meier survival analysis was utilized to assess patient prognoses across varying NPAR levels.
RESULTS
Elevated NPAR was associated with an increased risk of all-cause mortality and cancer-related mortality in cancer patients (p < 0.05), with higher NPAR values correlating with greater risk (p-trend < 0.05). However, no significant association between NPAR and cancer incidence was observed (p > 0.05). Our analysis further identified a non-linear relationship between NPAR and all-cause mortality risk (p-nonlinear < 0.05), while no non-linear relationship was found with cancer-related mortality risk. The relationship is characterized by an optimal NPAR value, correlating with the lowest hazard ratio (HR). Deviations from this optimal NPAR result in increased all-cause mortality risk (p < 0.05). Kaplan-Meier analysis indicated superior survival rates in patients with lower NPAR values compared to those with higher NPAR values (p < 0.05).
CONCLUSIONS
According to our study, higher NPAR was associated with an increased risk of all-cause mortality and cancer-related mortality in cancer patients.
背景
中性粒细胞与肿瘤细胞相互作用，可能会加剧癌症进展。此外，白蛋白水平降低是癌症预后不良的一个标志。中性粒细胞百分比与白蛋白比值（NPAR）已被用于非癌症疾病的预后评估，但其与癌症患者死亡风险的关系尚未得到探讨。因此，我们利用美国国家健康与营养检查调查（NHANES）的数据，研究NPAR与癌症患者全因死亡率和癌症相关死亡率风险之间的相关性。
方法
本研究利用了2005年至2016年期间NHANES的综合数据。我们使用加权逻辑回归和Cox回归模型以及趋势检验，分析了NPAR与癌症发病率、全因死亡率和癌症相关死亡率风险之间的关系。采用受限立方样条分析来研究NPAR与死亡风险的非线性关系。此外，利用Kaplan-Meier生存分析来评估不同NPAR水平患者的预后。
结果
NPAR升高与癌症患者全因死亡率和癌症相关死亡率风险增加相关（p < 0.05），NPAR值越高，风险越大（p趋势 < 0.05）。然而，未观察到NPAR与癌症发病率之间存在显著关联（p > 0.05）。我们的分析进一步确定了NPAR与全因死亡率风险之间存在非线性关系（p非线性 < 0.05），而与癌症相关死亡率风险未发现非线性关系。这种关系的特征是存在一个最佳NPAR值，与最低风险比（HR）相关。偏离这个最佳NPAR值会导致全因死亡率风险增加（p < 0.05）。Kaplan-Meier分析表明，与NPAR值较高的患者相比，NPAR值较低的患者生存率更高（p < 0.05）。
结论
根据我们的研究，较高的NPAR与癌症患者全因死亡率和癌症相关死亡率风险增加相关。
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