Correlation Analysis Of Inflammatory Indexes And Nutritional Indexes On Prognosis Of Small Cell Lung Cancer

Background:Small cell lung cancer(SCLC)is a highly invasive neuroendocrine tumor derived from bronchial epithelial cells.It is a special subtype of lung cancer,accounting for 15%to 20% of all lung cancers.It has characteristics such as high malignancy,short doubling time,early and widespread metastasis,and most patients are already in advanced stage at the time of diagnosis.Its occurrence is closely related to exposure to tobacco carcinogens.Typical respiratory symptoms include cough,dyspnea,and hemoptysis.Imaging findings include a central lung mass,often accompanied by enlarged thoracic lymph nodes.SCLC can be divided into localized and extensive stages based on the extent of the lesion,with approximately two-thirds of patients in the extensive stage at the time of diagnosis.SCLC is sensitive to chemotherapy and radiotherapy.Platinum based chemotherapy regimens can temporarily alleviate the clinical symptoms of patients with SCLC,but they are prone to secondary drug resistance,easy to relapse,and generally have a poor prognosis.In recent years,a large number of domestic and foreign scholars have studied the clinical indicators for predicting the prognosis of lung cancer patients,and it has been confirmed that many new biomarkers are related to the prognosis of lung cancer patients,especially non-small cell lung cancer.Currently,in research related to the prognosis of SCLC,there are few prognostic indicators that can be used to predict prognosis,and some novel indicators have been found.However,they are expensive and timeconsuming,and are not easily popularized in clinical practice.Some common clinical detection indicators,such as neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR)Lymphocyte to monocyte ratio(LMR),serum albumin to globulin ratio(AGR),prognostic nutritional index(PNI),and other indicators have been proven to be related to survival and prognosis in a variety of tumors.These indicators are not only cheap,simple,and easy to obtain,but also can objectively reflect the impact of immune,nutritional status,and inflammatory microenvironment on the prognosis of SCLC.For SCLC,most studies only propose 1-2 predictive indicators,or study inflammatory indicators or nutritional indicators alone.Few studies have explored multiple predictive indicators in the same included sample,or the combination of inflammatory and nutritional indicators to predict the prognosis of patients.Therefore,this study aims to explore the relationship between inflammatory and nutritional related indicators,as well as clinicopathological factors,and the prognosis of patients with small cell lung cancer,A nomogram model for predicting survival was established to more intuitively predict the prognosis of patients with small cell lung cancer.Objective:The purpose of this study was to explore the impact of composite indicators such as NLR,PLR,LMR,AGR,and PNI before treatment and clinicopathological factors on the prognosis of small cell lung cancer patients,and to establish a nomograph model for predicting the survival rate of SCLC patients based on this.Methods:According to the inclusion and exclusion criteria,153 patients with small cell lung cancer admitted to Bethune First Hospital of Jilin University from January 2018 to December 2022 were screened.The electronic case system is used to collect patient’s basic information,tumor stage,metastatic site,whole blood cell count at initial treatment,biochemistry,liver function,neuron specific enolase(NSE),coagulation routine,and other indicators.Peripheral blood NLR,PLR,LMR,AGR,and PNI were obtained through calculation.Establish a subject work characteristic curve(ROC)to determine the optimal cutoff value for each inflammatory and nutritional index,and group them according to the cutoff value.A single factor survival analysis of overall survival(OS)was performed using Kaplan Meier method.The COX proportional risk model was used to perform a multivariate survival analysis of OS.P <0.05 indicates a statistically significant difference.A nomograph model for predicting patient survival was established using R software,and the accuracy of the model was evaluated using a consistency index(C-index).Results:(1)A total of 153 patients with a mean age of(60.17 ± 8.64)years were included in this study,including 100 males and 53 females;About half of the patients are 75smokers;There were 70 patients in extensive stage and 83 patients in limited stage;Brain metastasis occurred in 13 cases;21 cases of bone metastasis;Adrenal metastasis in 9 cases;14 cases of liver metastasis;113 cases had elevated NSE at the time of initial treatment;38 patients developed hyponatremia.(2)According to the ROC curve,the optimal cutoff values for NLR,PLR,LMR,AGR,and PNI before treatment were 3.25,141.41,3.45,1.35,and 52.28,respectively.(3)The relationship between NLR,PLR,LMR,AGR,PNI and clinicopathological factors: NLR,PLR,and LMR were statistically significant in blood sodium levels and FBG(P <0.05);AGR was associated with gender,brain metastasis,NSE,and FBG(P <0.05);PNI is associated with adrenal metastasis and FBG(P <0.05);(4)Univariate analysis showed that age,tumor stage,liver metastasis,NSE,FBG,NLR,PLR,LMR,AGR and PNI were risk factors for the prognosis of patients with small cell lung cancer(P <0.05).Multivariate analysis showed that tumor stage,bone metastasis,blood Na level,NLR and PLR were independent risk factors for the prognosis of patients with small cell lung cancer(P<0.05).(5)According to the independent risk factors,the nomogram model for predicting OS in patients with small cell lung cancer was constructed,and the predictive performance of prognosis nomogram was evaluated.Conclusion:(1)Nutritional indexes(AGR,PNI)and inflammatory indexes(NLR,PLR,LMR)are all related to OS in patients with small cell lung cancer,but nutritional indexes are not independent risk factors for the prognosis of SCLC;NLR and PLR are independent risk factors for the prognosis of SCLC patients.(2)Patients with high NLR(>3.25)and high PLR(>141.41)have short survival time and poor prognosis,so we should pay close attention to the disease changes.(3)Based on the inflammatory composite index and clinicopathological factors,a Nomogram for predicting the survival rate of SCLC was established,and the Calibration analysis indicated that the model had good accuracy.