| 周卉,刘汇泉,李来玲,等.红细胞分布宽度/白蛋白比值预测免疫治疗非小细胞肺癌患者的临床效果[J].中国临床保健杂志,2025,28(5):673-678. |
| 红细胞分布宽度/白蛋白比值预测免疫治疗非小细胞肺癌患者的临床效果 |
| Clinical study on red blood cell distribution width/albumin ratio in predicting the efficacy of immunotherapy in patients with non-small cell lung cancer |
| 投稿时间：2025-04-11 |
| DOI：10.3969/J.issn.1672-6790.2025.05.018 |
| 中文关键词: 癌,非小细胞肺 红细胞指数 白蛋白类 预后 危险因素 |
| 英文关键词: Carcinoma,Non-small-cell lung erythrocyte indices Albumins Prognosis Risk factors 〖FL |
| 基金项目:国家自然科学基金项目(82304347) |
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| 摘要点击次数: 38 |
| 全文下载次数: 20 |
| 中文摘要: |
| 目的 探讨红细胞分布宽度/白蛋白比值(RAR)预测免疫治疗非小细胞肺癌(NSCLC)患者效果的应用价值。方法 回顾性分析2019年6月至2022年12月在中国科学技术大学附属第一医院(安徽省立医院)进行免疫治疗的96例NSCLC患者的临床资料。收集患者首次治疗前1周内的红细胞分布宽度(RDW)、白蛋白(ALB)检测结果,计算RAR。依据受试者工作特征(ROC)曲线RAR的最佳截断值将患者分为高RAR组、低RAR组。分析RAR与NSCLC患者临床特征的关系；采用Kaplan-Meier生存曲线比较2组患者的总生存期(OS)和无进展生存期(PFS)；采用多因素Cox回归分析影响免疫治疗NSCLC患者预后的危险因素。结果ROC曲线显示,RAR预测NSCLC免疫治疗患者预后的AUC为0.793,最佳截断值为0.48,灵敏度为88.79%,特异度为60.15%。高RAR组(RAR≥ 0.48,n=54)和低RAR组(RAR＜0.48,n=42)NSCLC患者在性别、吸烟、脑转移、骨转移等方面,差异无统计学意义(P＞0.05)；2组NSCLC患者年龄、病理类型、TNM分期、肝转移、疗效比较,差异有统计学意义(P＜0.05)；高 RAR 组患者更常见于年龄 ≥60 岁者(P=0.001),其病理类型以鳞癌居多(P=0.037),TNM 分期多为Ⅲ期(P=0.032),且更常并发肝转移(P=0.003),疾病稳定和部分缓解状态也更常见(P=0.018)。Kaplan-Meier生存分析结果表明,高RAR组的中位OS和中位PFS分别为12.7个月和6.1个月,明显短于低RAR组的22.9个月和9.6个月(P＜0.05)。单因素分析显示,年龄、吸烟、病理类型、TNM分期、肝转移、RAR是免疫治疗NSCLC患者OS的影响因素(P＜0.05)；年龄、病理类型、TNM分期、RAR是NSCLC免疫治疗患者PFS的影响因素(P＜0.05)。多因素分析显示,肝转移(HR=2.986,95%CI:1.732~5.149)、RAR≥0.48(HR=3.180,95%CI:1.834~5.517)是免疫治疗NSCLC患者影响OS的独立危险因素(P<0.05)；TNM Ⅳ期(HR=2.667,95%CI:1.587~4.483)、RAR≥0.48(HR=3.367,95%CI:1.892~5.991)是免疫治疗NSCLC患者PFS的独立危险因素(P<0.05)。结论 RAR升高是NSCLC患者预后的独立危险因素,RAR对预测免疫治疗NSCLC患者的疗效有一定临床价值。 |
| 英文摘要: |
| Objective To explore the application value of the red blood cell distribution width/albumin ratio (RAR) in predicting the efficacy of immunotherapy in patients with non-small cell lung cancer (NSCLC).Methods A retrospective analysis was conducted on the clinical data of 96 NSCLC patients who received immunotherapy in the First Affiliated Hospital of University of Science and Technology of China from June 2019 to July 2022.The test results of red blood cell distribution width (RDW) and albumin (ALB) within 1 week before the first treatment were collected,and RAR was calculated.Patients were divided into high and low RAR groups according to the optimal cut-off value of RAR determined by the receiver operating characteristic (ROC) curve.The relationship between RAR and the clinical characteristics of NSCLC patients was analyzed.Kaplan-Meier survival curves were used to compare the overall survival (OS) and progression-free survival (PFS) between the two groups.Multivariate Cox regression analysis was performed to identify the risk factors affecting the prognosis of NSCLC patients receiving immunotherapy.Results The ROC curve showed that the area under the curve (AUC) of RAR for predicting the prognosis of NSCLC patients receiving immunotherapy was 0.793,with the optimal cut-off value of 0.48,the sensitivity of 88.79% and the specificity of 60.15%.There were no statistically significant differences in gender,smoking status,brain metastasis,bone metastasis,etc.between NSCLC patients in the high RAR group (RAR ≥ 0.48,n=54) and the low RAR group (RAR<0.48,n=42) (P>0.05).There were statistically significant differences in age,pathological type,TNM stage,liver metastasis,and efficacy between the two groups of NSCLC cases (P<0.05).In the high RAR group,patients aged ≥60 years were more common (P=0.001);the pathological type was mostly squamous cell carcinoma (P=0.037);the TNM stage was mostly stage Ⅲ (P=0.032);liver metastasis was more frequently concurrent (P=0.003);and the statuses of stable disease and partial remission were also more common (P=0.018).Results of Kaplan-Meier survival analysis showed that the median OS and median PFS in the high RAR group were 12.7 months and 6.1 months,respectively,which were significantly shorter than those in the low RAR group (22.9 months and 9.6 months,P<0.05).Univariate analysis revealed that age,smoking status,pathological type,TNM stage,liver metastasis,and RAR were influencing factors for OS in NSCLC patients receiving immunotherapy (P<0.05);age,pathological type,TNM stage,and RAR were influencing factors for PFS in NSCLC patients receiving immunotherapy (P<0.05).Multivariate analysis indicated that liver metastasis (HR=2.986,95%CI:1.732-5.149) and RAR ≥ 0.48 (HR=3.180,95%CI:1.834-5.517) were independent risk factors affecting OS in NSCLC patients treated with immunotherapy (P<0.05);TNM stage Ⅳ (HR=2.667,95%CI:1.587-4.483) and RAR ≥ 0.48 (HR=3.367,95%CI:1.892-5.991) were independent risk factors affecting PFS in NSCLC patients treated with immunotherapy (P<0.05).Conclusions An elevated RAR is an independent risk factor for the prognosis of NSCLC patients,and RAR has certain clinical value in predicting the efficacy of immunotherapy in NSCLC patients. |
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