PIV和AAPR对非小细胞肺癌伴脑转移患者的预后评估价值

doi:10.3969/j.issn.1004-616x.2023.01.008

摘要/Abstract

摘要： 目的: 探讨泛免疫-炎症指数(PIV)和白蛋白-碱性磷酸酶比值(AAPR)对非小细胞肺癌伴脑转移患者的预后评估价值。方法: 回顾性分析2015年12月—2022年4月在郑州大学第二附属医院初诊的102例非小细胞肺癌伴脑转移患者的病例资料，包括患者基本临床病理特征、治疗过程中头部放疗情况、基线实验室资料等，通过血常规及肝功能指标计算出PIV、AAPR、系统免疫炎症指数(SII)、中性粒细胞/淋巴细胞比值(NLR)、衍生中性粒细胞/淋巴细胞比值(dNLR)、血小板/淋巴细胞比值(PLR)、淋巴细胞/单核细胞比值(LMR)，通过X-tile软件计算预测非小细胞肺癌伴脑转移患者预后的PIV和AAPR等的最佳截断值。采用χ²检验或Fisher确切概率法评估非小细胞肺癌伴脑转移患者PIV、AAPR与临床病理指标之间的相关性。采用单变量和多变量Cox比例风险回归模型，分析这些变量和临床结局之间的相关性，探讨影响非小细胞肺癌伴脑转移患者生存的因素，并通过R软件绘制生存曲线。结果: PIV、AAPR、SII、NLR、dNLR、PLR、LMR的截断值分别为221.9、0.6、1 039.4、5.2、4.0、223.7、4.5，根据截断值将PIV、AAPR等分为高(≥截断值)、低(<截断值)两组。单因素Cox回归模型分析显示，PIV、AAPR、SII、NLR、dNLR、LMR高、低水平组患者的生存曲线比较，差异具有统计学意义(P<0.05)。多因素Cox回归模型的分析显示，PIV和AAPR对患者预后有一定的影响(均为P<0.05)。结论: PIV和AAPR可作为预测非小细胞肺癌伴脑转移患者预后的生物标志物，高PIV(≥221.9)、低AAPR(<0.6)与非小细胞肺癌伴脑转移患者较差的临床结局相关，PIV和AAPR可能在预测患者预后方面具有一定的临床应用及科研价值。

关键词: 非小细胞肺癌, 脑转移, 泛免疫-炎症指数, 白蛋白, 碱性磷酸酶

Abstract: OBJECTIVE: To investigate prognostic values of pan-Immune-inflammation index (PIV) and albumin to alkaline phosphatase ratio (AAPR) in non-small cell lung cancers with brain metastasis. METHODS: From the Second Affiliated Hospital of Zhengzhou University，the case data of 102 non-small-cell lung cancer patients with brain metastasis from December 2015 to April 2022 were retrospectively analyzed. The data included patients' basic clinicopathological characteristics，head radiotherapy status，baseline laboratory data，etc. PIV，AAPR，systemic immune inflammatory index (SII)，neutrophil/lymphocyte ratio (NLR)，derived neutrophil/lymphocyte ratio (dNLR)，platelet/lymphocyte ratio (PLR) and lymphocyte/monocyte ratio (LMR) were calculated using the blood routine and liver function test results. The best cut-off values of PIV，AAPR，etc for predicting the prognosis of the cancer cases were calculated using the X-tile software. χ² test or Fisher--s-exact-test-was used to evaluate correlations between PIV，AAPR and various clinicopathological indicators. Univariate and multivariate Cox proportional hazard regression models were used to analyze possible correlations between these variables and clinical outcomes，and to explore factors affecting the survival of the patients. Survival curves were drawn using the R software. RESULTS: The cutoff values for PIV，AAPR，SII，NLR，dNLR，PLR，and LMR were 221.9，0.6，1 039.4，5.2，4.0，223.7，and 4.5，respectively. The univariate Cox regression model showed that the survival curves of PIV，AAPR，SII，NLR，dNLR，LMR in different levels were statistically significant (P<0.05). The multivariate Cox regression model showed that PIV and AAPR had a certain impact on the prognosis of patients (P<0.05). CONCLUSION: Our results show that high PIV (≥221.9) and low AAPR (<0.6) were related to poor clinical outcomes. Thus，PIV and AAPR can be used as biomarkers to predict prognosis of non-small cell lung cancer patients with brain metastasis.

Key words: non-small cell lung cancer, brain metastasis, pan-immune-inflammation value, albumin, alkaline phosphatase

中图分类号:

R734.2

靳爽, 李坤, 陈泓润, 张中冕. PIV和AAPR对非小细胞肺癌伴脑转移患者的预后评估价值[J]. 癌变·畸变·突变, 2023, 35(1): 43-48.

JIN Shuang, LI Kun, CHEN Hongrun, ZHANG Zhongmian. Prognostic value of PIV and AAPR in patients with non-small cell lung cancer with brain metastasis[J]. Carcinogenesis, Teratogenesis & Mutagenesis, 2023, 35(1): 43-48.

参考文献

[1] 秦叔逵, 苗静, 韩宝惠, 等. 重组人血管内皮抑制素联合常用含铂化疗方案治疗晚期非小细胞肺癌的Ⅳ期临床研究[J]. 临床肿瘤学杂志, 2019, 24(4):289-298.
[2] 孙爽, 门玉, 惠周光. 非小细胞肺癌脑转移高危因素研究进展[J]. 中国肺癌杂志, 2022, 25(3):193-200.
[3] YANG M, ZHANG Q, GE Y Z, et al. Prognostic roles of inflammation- and nutrition-based indicators for female patients with cancer[J]. J Inflamm Res, 2022, 15:3573-3586.
[4] FUCÀ G, GUARINI V, ANTONIOTTI C, et al. The Pan-Immune-Inflammation Value is a new prognostic biomarker in metastatic colorectal cancer:results from a pooled-analysis of the Valentino and TRIBE first-line trials[J]. Br J Cancer, 2020, 123(3):403-409.
[5] PÉREZ-MARTELO M, GONZÁLEZ-GARCÍA A, VIDAL-ÍNSUA Y, et al. Clinical significance of baseline Pan-Immune-Inflammation Value and its dynamics in metastatic colorectal cancer patients under first-line chemotherapy[J]. Sci Rep, 2022, 12:6893.
[6] TOPKAN E, SELEK U, KUCUK A, et al. Low pre-Chemoradiotherapy Pan-immune-inflammation value (PIV) measures predict better survival outcomes in locally advanced pancreatic adenocarcinomas[J]. J Inflamm Res, 2022, 15:5413-5423.
[7] YAZGAN S C, YEKEDÜZ E, UTKAN G, et al. Prognostic role of pan-immune-inflammation value in patients with metastatic castration-resistant prostate cancer treated with androgen receptor-signaling inhibitors[J]. Prostate, 2022, 82(15):1456-1461.
[8] ŞAHIN A B, CUBUKCU E, OCAK B, et al. Low pan-immune-inflammation-value predicts better chemotherapy response and survival in breast cancer patients treated with neoadjuvant chemotherapy[J]. Sci Rep, 2021, 11:14662.
[9] FUCÀ G, BENINATO T, BINI M, et al. The pan-immune-inflammation value in patients with metastatic melanoma receiving first-line therapy[J]. Targ Oncol, 2021, 16(4):529-536.
[10] LI J H, ZUO M R, ZHOU X W, et al. Prognostic significance of preoperative albumin to alkaline phosphatase ratio in patients with glioblastoma[J]. J Cancer, 2021, 12(19):5950-5959.
[11] ZHANG F, LU S X, HU K S, et al. Albumin-to-alkaline phosphatase ratio as a predictor of tumor recurrence and prognosis in patients with early-stage hepatocellular carcinoma undergoing radiofrequency ablation as initial therapy[J]. Int J Hyperth, 2021, 38(1):1-10.
[12] ZHU X Y, CHEN D N, LI S J, et al. Albumin-to-alkaline phosphatase ratio as a novel and promising prognostic biomarker in patients undergoing esophagectomy for carcinoma:a propensity score matching study[J]. Front Oncol, 2021, 11:764076.
[13] WON I, SHIM S R, KIM S I, et al. Albumin-to-alkaline phosphatase ratio as a novel prognostic factor in patients undergoing nephrectomy for non-metastatic renal cell carcinoma:propensity score matching analysis[J]. Clin Genitourin Cancer, 2022, 20(3):e253-e262.
[14] CERTO M, TSAI C H, PUCINO V, et al. Lactate modulation of immune responses in inflammatory versus tumour microenvironments[J]. Nat Rev Immunol, 2021, 21(3):151-161.
[15] 覃凤娴, 刘小勇, 陈翔. 肿瘤相关中性粒细胞在肿瘤靶向治疗中的研究进展[J]. 中国免疫学杂志, 2021, 37(21):2647-2652.
[16] 周发权, 陈师, 孙红玉, 等. 系统免疫炎症指数与胰腺癌患者预后关系的系统评价和Meta分析[J]. 中国普通外科杂志, 2020, 29(9):1076-1083.
[17] OLINGY C E, DINH H Q, HEDRICK C C. Monocyte heterogeneity and functions in cancer[J]. J Leukoc Biol, 2019, 106(2):309-322.
[18] LI X G, LI B T, ZENG H Y, et al. Prognostic value of dynamic albumin-to-alkaline phosphatase ratio in limited stage small-cell lung cancer[J]. Future Oncol, 2019, 15(9):995-1006.
[19] ZHAO H Z, CHEN X Y, ZHANG W H, et al. Pan-immune-inflammation value is associated with the clinical stage of colorectal cancer[J]. Front Surg, 2022, 9:996844.
[20] LIN F, ZHANG L P, XIE S Y, et al. Pan-immune-inflammation value:a new prognostic index in operative breast cancer[J]. Front Oncol, 2022, 12:830138.
[21] ZENG R, LIU F, FANG C, et al. PIV and PILE score at baseline predict clinical outcome of anti-PD-1/PD-L1 inhibitor combined with chemotherapy in extensive-stage small cell lung cancer patients[J]. Front Immunol, 2021, 12:724443.
[22] CHEN X, HONG X, CHEN G, et al. The Pan-Immune-Inflammation Value predicts the survival of patients with anaplastic lymphoma kinase-positive non-small cell lung cancer treated with first-line ALK inhibitor[J]. Transl Oncol, 2022, 17:101338.
[23] ZHOU S Z, JIANG W, WANG H L, et al. Predictive value of pretreatment albumin-to-alkaline phosphatase ratio for overall survival for patients with advanced non-small cell lung cancer[J]. Cancer Med, 2020, 9(17):6268-6280.