Jin Linling, Zhou Shulan, Huang Lei, He Yiting, Zhang Jiayi, Chen Ling, Kong Hui, Xie Weiping, He Mengyu
Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital With Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China.
Department of Respiratory and Critical Care Medicine, the Second Affiliated Hospital of Soochow University, Suzhou, 215004, Jiangsu, China.
Eur J Med Res. 2025 Apr 22;30(1):316. doi: 10.1186/s40001-025-02595-3.
Combined pulmonary fibrosis and emphysema (CPFE) represents a distinct clinical syndrome characterized by the coexistence of upper lobe emphysema and lower lobe fibrosis, with an increased risk of lung cancer (LC) development. This study aimed to detect the clinical features and prognosis of CPFE patients with LC and the ability of neutrophil-to-lymphocyte ratio (NLR) to predict outcomes in those individuals.
A retrospective cohort study involving patients diagnosed with CPFE combined with LC between January 2017 and December 2023 was conducted. Clinical characteristics, laboratory parameters and survival data were collected.
A total of 80 CPFE patients with LC were included, with a mean age of 68.1 years, and a male predominance (93.8%). The LCs were predominantly adenocarcinomas (38.8%), with a significant proportion diagnosed at advanced stages (22.5% at stage III, 47.5% at stage IV) and preferential peripheral pulmonary localization (72.5%). CPFE patients with LC had estimated 1-year, 3-year, and 5-year survival rates of 52%, 40%, and 37%, respectively, with a median overall survival of 29.2 months. Multivariate Cox regression analysis revealed that increased NLR [adjusted hazard ratio (HR) 1.180, 95% confidence interval CI 1.029-1.352, p = 0.018] and elevated carcinoembryonic antigen (CEA) (adjusted HR 1.005, 95% CI 1.000-1.010, p = 0.036) were related to an enhanced risk of all-cause mortality. Receiver-operating characteristic analysis identified an NLR cutoff value of 2.6 as a predictor of all-cause death within 24 months [area under the curve = 0.651; specificity = 62.1%; sensitivity = 66.6%; p < 0.05]. Patients with an NLR greater than 2.6 had a significantly greater risk of all-cause death than those with an NLR of 2.6 or less (adjusted HR 2.3, 95% CI 1.197-4.754; p = 0.011).
The NLR may serve as a cost-effective and widely accessible biomarker for risk stratification, particularly in CPFE patients with advanced-stage LC. In our cohort, an NLR cutoff value of 2.6 provides improved prognostic accuracy in predicting mortality outcomes.
合并肺纤维化和肺气肿（CPFE）是一种独特的临床综合征，其特征为上叶肺气肿和下叶纤维化并存，肺癌（LC）发生风险增加。本研究旨在检测合并LC的CPFE患者的临床特征和预后，以及中性粒细胞与淋巴细胞比值（NLR）预测这些患者预后的能力。
进行一项回顾性队列研究，纳入2017年1月至2023年12月期间诊断为CPFE合并LC的患者。收集临床特征、实验室参数和生存数据。
共纳入80例合并LC的CPFE患者，平均年龄68.1岁，男性占主导（93.8%）。LC主要为腺癌（38.8%），相当比例在晚期诊断（III期占22.5%，IV期占47.5%），且多位于肺外周（72.5%）。合并LC的CPFE患者的1年、3年和5年估计生存率分别为52%、40%和37%，总生存中位数为29.2个月。多因素Cox回归分析显示，NLR升高[调整后风险比（HR）1.180，9%置信区间CI 1.029 - 1.352，p = 0.018]和癌胚抗原（CEA）升高（调整后HR 1.005，95% CI 1.000 - 1.010，p = 0.036）与全因死亡风险增加相关。受试者工作特征分析确定NLR临界值为2.6可作为24个月内全因死亡的预测指标[曲线下面积 = 0.651；特异性 = 62.1%；敏感性 = 66.6%；p < 0.05]。NLR大于2.6的患者全因死亡风险显著高于NLR为2.6或更低的患者（调整后HR 2.3，95% CI 1.197 - 4.754；p = 0.011）。
NLR可作为一种经济有效且广泛可用的生物标志物用于风险分层，尤其是在晚期LC的CPFE患者中。在我们的队列中，NLR临界值2.6在预测死亡结局方面具有更高的预后准确性。
