Tan Sihan, Li Weimin, Tian Panwen
Department of Pulmonary and Critical Care Medicine/Lung Cancer Institute, State Key Laboratory of Respiratory Health and Multimorbidity, Precision Medicine Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu 610041, China.
Zhongguo Fei Ai Za Zhi. 2024 Dec 20;27(12):931-939. doi: 10.3779/j.issn.1009-3419.2024.106.33.
A prognostic nutritional index (PNI) developed by nutritional status and inflammation are closely associated with poor prognosis in malignant tumors. However, the predictive impact of PNI in patients with malignant pleural effusion (MPE) remains inconclusive. The study aimed to determine the predictive value of PNI in prognosis and spontaneous pleurodesis among patients with MPE.
The patients diagnosed with advanced non-small cell lung cancer (NSCLC) with MPE in West China Hospital between January 2015 and December 2022 were reviewed and allocated randomly to development set(60%) and validation set(40%). After collecting clinical data, peripheral blood inflammation indices and calculating systemic inflammation indices, the effects of PNI on prognosis and spontaneous pleurodesis have been evaluated by Cox proportional hazards models, Kaplan-Meier method and Nelson-Aalen cumulative risk curve.
In total, 261 patients diagnosed NSCLC with MPE were selected (development set: n=157; validation set: n=104), of whom 58.2% were aged <65 years, 53.6% were male and 95.8% were diagnosed with adenocarcinoma. The dichotomous cut-off value for PNI was 44.1, respectively. Compared with lower PNI (PNI<44.1) cases, patients with higher PNI (PNI≥44.1) showed significantly longer overall survival (36.5 vs 24.3 mon, P=0.02) and higher incidence of spontaneous pleurodesis (P=0.009). According to the multivariate Cox analysis, higher PNI was associated with good prognosis and successful spontaneous pleurodesis (P<0.05). According to the results of Cox regression analysis, the PNI-prognosis and PNI-spontaneous pleurodesis models are determined, the receiver operating characteristic (ROC) curves are drawn, and the area under the curves (AUC) value of development set are 0.694 (95%CI: 0.620-0.776) and 0.673 (95%CI: 0.590-0.737).
PNI is a reliable biomarker of prognosis and spontaneous pleurodesis in patients with MPE. Attention to the patient's nutritional status and inflammation may improve the prognosis and efficacy of pleural effusion.
由营养状况和炎症指标制定的预后营养指数（PNI）与恶性肿瘤的不良预后密切相关。然而，PNI对恶性胸腔积液（MPE）患者的预测价值仍不明确。本研究旨在确定PNI在MPE患者预后及胸膜固定术中的预测价值。
回顾性分析2015年1月至2022年12月在华西医院诊断为晚期非小细胞肺癌（NSCLC）并伴有MPE的患者，并随机分为训练集（60%）和验证集（40%）。收集临床资料、外周血炎症指标并计算全身炎症指标后，采用Cox比例风险模型、Kaplan-Meier法和Nelson-Aalen累积风险曲线评估PNI对预后和胸膜固定术的影响。
共纳入261例诊断为NSCLC并伴有MPE的患者（训练集：n = 157；验证集：n = 104），其中58.2%年龄<65岁，53.6%为男性，95.8%诊断为腺癌。PNI的二分法临界值分别为44.1。与PNI较低（PNI<44.1）的患者相比，PNI较高（PNI≥44.1）的患者总生存期显著更长（36.5个月对24.3个月，P = 0.02），胸膜固定术发生率更高（P = 0.009）。多因素Cox分析显示，较高的PNI与良好的预后和成功的胸膜固定术相关（P<0.05）。根据Cox回归分析结果，确定了PNI-预后和PNI-胸膜固定术模型，绘制了受试者工作特征（ROC）曲线，训练集的曲线下面积（AUC）值分别为0.694（95%CI：0.620 - 0.776）和0.673（95%CI：0.590 - 0.737）。
PNI是MPE患者预后和胸膜固定术的可靠生物标志物。关注患者的营养状况和炎症反应可能改善胸腔积液的预后和疗效。
