Page 38 - 中国全科医学2022-17

http://www.chinagp.net E-mail:zgqkyx@chinagp.net.cn ·2083·

【Abstract】 Background In China，elderly patients with non-small cell lung cancer（NSCLC） accounts for the
highest percentage of lung cancer patients，and most of them are found to have no surgical possibilities at the time of diagnosis.
Moreover，these patients are increasing as aging advances. Increasing their survival rate will help to reduce the overall mortality
of lung cancer patients. So identifying effective prognostic indicators in NSCLC patients with non-surgical treatment is of great
significance in prognostic stratification，which also contributes to clinical studies aiming at improving the survival rate of such
patients via prognostic stratification-based treatments. Objective To investigate the relationship between systemic immune-
inflammatory-nutritional index （SIINI） and survival in non-surgically treated elderly patients with NSCLC. Methods Patients
（n=231，≥65 years old） with first treatment for NSCLC were retrospectively recruited from Hebei General Hospital from January 1，
2014 to June 30，2018. Clinical characteristics were collected，mainly including age，sex，prevalence of smoking，baseline
diseases，BMI，pathology，differentiation，and clinical stage of NSCLC. Some calculated data based on baseline routine blood
test parameters，and/or serum albumin，and/or BMI using different approaches were also collected，including neutrophil to
lymphocyte ratio（NLR），derived NLR（dNLR），platelet to lymphocyte ratio（PLR），prognostic nutrition index（PNI），
systemic immune-inflammation index（SII），advanced lung cancer inflammatory index（ALI） and SIINI 〔using a formula
proposed in clinical retrospective studies，in which all variables are measured before treatment：（neutrophil count×platelet
count×hemoglobin level）/（lymphocyte count×BMI×serum albumin level）〕. Post-treatment follow-up was conducted
till February 1，2020 through outpatient reexamination，telephone or text messages with death as the endpoint. For assessing
prognostic values of NLR，dNLR，PLR，PNI，SII，ALI and SIINI，ROC analysis was performed with defined optimal cut-
off value and the area under the curve（AUC） for each indicator（if the AUC value is less than 0.5，then the optimal cut-off
value is defined using the median value，by which the AUC value is defined as large or small when it is greater or less than the
value）. The survival curves were comparatively analyzed by different patient characteristics. Cox regression analysis was applied
to identify the influencing factors of survival. The survival rate curve was visualized using GraphPad Prism 8.0.2. Results The
optimal cut-off values using NLR，dNLR，PLR，PNI，SII，ALI and SIINI in assessing the prognosis were 3.30，2.51，
179.99，273.65，736.54，46.05 and 102.89，respectively. The survival curves varied significantly by age，sex，prevalence of
smoking，pathology，differentiation，and clinical stage of NSCLC，NLR，dNLR，PLR，ALI，SII，PNI and SIINI （P<0.05）.
Further analysis indicated that the difference between the survival curves of 65-70-year-olds and 76-and-over-year-olds was
statistically significant（P<0.05）. The survival curves between those with low or moderate differentiation and those with high
differentiation were significantly different（P<0.05）. The survival curves of patients with stage Ⅰ NSCLC were different from
those of patients with stage Ⅱ，Ⅲ or Ⅳ NSCLC（P<0.05）. Cox regression analysis revealed that ≥ 76 years old（P<0.001），
highly differentiated NSCLC（P<0.001），stage Ⅲ NSCLC（P=0.012） and Ⅳ NSCLC（P<0.001） and SIINI（P=0.001）
were prognostic factors of patients. Moreover，there existed significant differences in survival curves by NLR，dNLR，PLR，
ALI，SII，PNI，and SIINI（P<0.05）. Conclusion We found that SIINI，a new indictor calculated based on immunity，
inflammation and nutrition factors，is effective in predicting the overall survival in non-surgically treated elderly patients with
NSCLC，and it may be superior to NLR，dNLR，PLR，PNI，SII，ALI in terms of survival prediction-related application and
in-depth research.
【Key words】 Carcinoma，non-small-cell lung；Lung neoplasms；Aged；Peripheral blood cell count；Nutritional
status；Systematic immune-inflammation-nutritional index；Prognosis

2020 年全球癌症统计数据显示，肺癌仍是世界上 生的中性粒细胞 / 淋巴细胞比值（derived neutrophil to
发病率及死亡率较高的恶性肿瘤之一 ［1］ 。中国肺癌患 lymphocyte ratio，dNLR）、血小板 / 淋巴细胞比值（platelet
者死亡人数约占全部癌症死亡人数的四分之一，年龄 to lymphocyte ratio，PLR）、预后营养指数（prognostic
是导致中国肺癌发病率及死亡率升高的最主要原因， nutritional index，PNI）、系统免疫炎症指数（systematic
其中≥ 65 岁肺癌患者为主要群体 ［2］ ，而非小细胞肺 immune-inflammation index，SII）、晚期肺癌炎症指数
癌（non-small cell lung cancer，NSCLC） 占 所 有 肺 癌 （advanced lung cancer inflammatory index，ALI）和血红
的 80% 以上 ［3］ 。临床中通常将≥ 65 岁的 NSCLC 患 蛋白与 NSCLC 患者预后有内在联系 ［5-10］ 。本研究基于
者称为老年 NSCLC ［4］ ，如何降低该类患者的死亡率是 临床回顾性数据探索发现，将治疗前中性粒细胞计数、
不容忽视的问题，有效的预后判断指标对于患者后续 淋巴细胞计数、血小板计数、血红蛋白水平、血清白蛋
个体化治疗具有重要意义。研究表明中性粒细胞 / 淋 白水平、体质指数（BMI）以中性粒细胞计数 × 血小
巴细胞比值（neutrophil to lymphocyte ratio，NLR）、衍 板计数 × 血红蛋白水平 /（淋巴细胞计数 ×BMI× 血