| Objective:To investigate the relationship between systemic inflammatory response index(SIRI)and fibrinogen to albumin ratio(FAR)levels before chemotherapy and the curative effect and prognosis of patients with advanced non-small cell lung cancer(NSCLC),and to develop a preliminary nomograph model about prognosis based on SIRI and FAR.We expect that with the help of the preliminary nomograph model accurate stratification of tumor patients can be performed intuitively and quickly,and certain reference value can be provided for the selection of personalized treatment strategies in subsequent clinical decision-making.Methods:1.Clinical data and follow-up data of advanced NSCLC patients treated with first-line platinum-containing chemotherapy regimens admitted to the Affiliated Hospital of Jiangsu University from August 1,2017 to December 31,2021 were retrospectively analyzed.The response evaluation criteria in solid tumors 1.1(RECIST1.1)was used to evaluate the short-term efficacy after 4 treatment cycles,and the patients’ progression-free survival(PFS)and overall survival(OS)were calculated according to the follow-up data.2.The cut-off value of SIRI and FAR predicting the short-term efficacy、PFS and OS of patients were calculated according to the receiver operating characteristic curves(ROC).SIRI and FAR were divided into Low and High groups respectively according to the cut-off value.The chi-square test or Fisher’s precision probability test was used to compare the relationship between different SIRI and FAR level groups and the basic clinical characteristics of the patients respectively,while the Mann-Whitney rank sum test and chi-square test were used to analyze the short-term efficacy of patients in different SIRI and FAR level groups.Kaplan-Meier method was used for survival analysis and the Log-rank test for comparison of differences between groups,survival curves were plotted,and the proportional hazards models were applied to analyze independent prognostic factors which affect PFS and OS in patients with advanced NSCLC.3.A nomograph model for predicting survival in advanced NSCLC was developed and validated based on the independent prognostic factors for OS screened by the proportional hazards model,and the area under the curve(AUC)and calibration curve were used for internal verification.Results:1.A total of 264 patients were included through inclusion and exclusion criteria,including165 males and 99 females.There were 57 cases of squamous carcinoma,198 cases of adenocarcinoma,and 9 cases of other types.And 66 cases were stage III and 198 cases were stage IV.A total of 213 patients had disease progression,11 patients were not followed up until disease progression occurred due to loss of follow-up and 40 patients didn’t have disease progression.A total of 129 patients died,34 patients were not followed up until death occurred due to loss of follow-up or until the cut-off time for follow-up,and 101 patients survived by the follow-up cut-off time.2.The best cut-off values for SIRI and FAR predicting the patients’ short-term efficacy were 1.820 and 0.114 respectively according to the ROC curve.The overall efficacy evaluation of patients in the L-SIRI group was significantly better than that of the H-SIRI group,and the overall efficacy evaluation of patients in the L-FAR group was significantly better than that of the H-FAR group(both P<0.001)according to Mann-Whitney rank sum test.The objective response rate of the L-SIRI group was higher than that of the H-SIRI group(42.7% vs 28.9%,P= 0.022),the disease control rate was significantly higher in the L-SIRI group than in the H-SIRI group(87.3% vs 50.0%,P<0.001).The objective response rate and the disease control rate were both significantly higher in the L-FAR group than in the H-FAR group(49.7% vs12.0%,91.8% vs 40.0%,both P<0.001)according to chi-square test.3.The best cut-off value for SIRI predicting the patients’ PFS was 1.274 according to the ROC curve.Kaplan-Meier survival analysis and Log-rank test for comparison of differences between groups showed that SIRI,pathological staging,M-staging,sensitive gene mutation status and treatment regimen were predictors of PFS in patients with advanced NCSLC(all P<0.05).The proportional hazards model showed that SIRI and treatment regimen were independent prognostic factors affecting the patients’ PFS(all P<0.05).4.The best cut-off values for SIRI and FAR predicting the patients’ OS were 1.735 and0.087 respectively according to the ROC curve.Kaplan-Meier survival analysis and Log-rank test for comparison of differences between groups showed that SIRI,FAR,smoking status,pathological staging,M-staging,sensitive gene mutation status and treatment regimen were predictors of patient OS(all P<0.05).The proportional hazards model showed that SIRI,FAR,and treatment regimen were independent prognostic factors affecting the patients’ OS(all P<0.05).5.A nomograph model for predicting the patients’ 1-year and 3-year survival rates with advanced NSCLC was developed based on the independent prognostic factors for OS,with relatively good predictive power and the AUC of the 1-year survival rate was 0.814 and the AUC of the 3-year survival rate was 0.853 respectively.Conclusions:1.SIRI and FAR correlate with the short-term efficacy of patients with advanced NCSLC and can provide guidance for predicting the short-term efficacy of advanced NSCLC.2.SIRI,pathological staging,M-staging,sensitive gene mutation status and treatment regimen were associated with PFS in patients with advanced NCSLC,among which,SIRI and treatment regimen were independent prognostic factors affecting the patients’ PFS.SIRI,FAR,smoking status,pathological staging,M-staging,sensitive gene mutation status and treatment regimen were associated with OS in patients with advanced NCSLC,among which,SIRI,FAR,and treatment regimen were independent prognostic factors affecting the patients’ OS.3.In this study,a preliminary nomograph model for predicting survival rate of patients with advanced NSCLC based on SIRI and FAR was developed,and the model was internally validated to be of good accuracy. |
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