| BackgroundPulmonary neuroendocrine tumors(PNETs)are a special subtype of lung cancer,including small cell lung cancer,large cell neuroendocrine cancer,atypical carcinoid and typical carcinoid.The clinical manifestations and imaging characteristics of PNETs are not specific and easy to be misdiagnosed.Surgical resection is the main treatment for PNETs,while adjuvant treatment has certain therapeutic value for advanced patients.However,the occurrence and development of PNETs are not easy to predict because of the limitation of its histopathological value and the small number of histological or blood biomarkers that can effectively predict the prognosis.Therefore,it is of great clinical significance to explore new biological predictors.Inflammatory tumor microenvironment composed of inflammatory cells,immune cells and related mediators plays an important role in the occurrence,proliferation,development and metastasis of tumor.The neutrophil-lymphocyte ratio(NLR)and platelet-lymphocyte ratio(PLR)are widely used to predict the prognosis of esophageal squamous cell carcinoma and solid lymphocytic carcinoma.Similarly,preoperative systemic immune inflammatory index(SII)and prognostic nutritional index(PNI)are effective tumor biomarkers,which have important predictive value for the prognosis of many malignant tumors.However,there is no similar research on the predictive value of SII and PNI for operable PNETs.Our study aimed to clarify the predictive value of SII and PNI in PNETs patients after surgical resection.MethodsThis study retrospectively analysed the relevant clinical data of PNETs patients who received surgical treatment from 2005 to 2015,which was obtained from patient's clinical records,blood test results recorded on admission before surgical treatment,and follow-up by hospital records.The statistical analysis of the data in our study through the SPSS version 23.0.The receiver operating characteristic(ROC)curves was used to find out the cut-off values for PLR,NLR,SII and PNI with the highest Youden's index.Categorical variables were compared using the Pearson Chi-square test.The Kaplan-Meier method was used for survival analysis through univariate analysis,and log-rank test was used to assess the difference.Cox regression model was used for multivariate analysis to explore the independent risk factors associated with PLR,NLR,SII and PNI.The correlation degree between the factors and OS was assessed by hazard ratios(HRs)and 95 percent confidence intervals(CIs).P value<0.05 was regarded as Statistical difference significantly.ResultsA total of 381 PNETs patients were enrolled in this study,including 143(37.5%)patients with large cell neuroendocrine carcinoma,181(47.5%)patients with small cell lung cancer and 57(15.0%)patients with atypical carcinoid.Of the 381 patients,294(77.2%)were male and 87(22.8%)were female.266(69.8%)patients had a history of smoking,and 115(30.2%)patients never smoked.The age ranged from 19 to 94 years old,with a median of 60 years old.There were 142(37.3%)patients with stage ?,93(24.4%)patients with stage ?,142(37.3%)patients with stage ? and only 4(1.0%)patients with stage ?.The median of PLR,NLR,SII and PNI were 134.6,2.52,592.3 and 51.78,respectively.The optimal cut-off values of PLR,NLR,SII and PNI were 118.74,2.69,682.98 and 49.95,respectively.Preoperative PLR was significantly correlated with tumor length(P=0.001),tumor type(P=0.027),T stage(P=0.001)and TNM stage(P=0.038).Preoperative NLR was significantly correlated with tumor length(P=0.001),tumor type(P=0.001),TNM stage(P=0.007)and T stage(P=0.000).Preoperative PNI was associated with age(P=0.001),T stage(P=0.001),tumor length(P=0.002),drinking status(P=0.013)and smoking status(P=0.049),while SII was significantly associated with T stage(P=0.001),tumor length(P=0.001)and TNM stage(P=0.001).Patients with increased SII and NLR had poorer prognosis than those with decreased SII and NLR(P=0.001 and P=0.001),while patients with decreased PLR and PNI had poorer prognosis than those with increased PLR and PNI(P=0.001 and P<0.001).SII(P=0.002),neutrophil/lymphocyte ratio(NLR)(P<0.001),platelet/lymphocyte ratio(PLR)(P=0.001),lymph node metastasis(P<0.001),operation time(P=0.034<0.05),treatment(P<0.001)and PNI(P=0.044<0.05)were independent prognostic factors for PNETs identified by multivariate Cox regression analysis.ConclusionsHigh SII,NLR and low PNI,PLR suggest poor prognosis of PNETs.SII,NLR,PLR,lymph node metastasis,operation time,treatment methods and PNI were all independent prognostic factors of PNETs.SII and PNI can be used to predict the prognosis of patients with PNETs,and can be used to stratify patients for better treatment.BackgroundPrimary pulmonary lymphoma(PPL)is a rare extranodal lymphoma originating from the lung,accounting for 0.5-1.0%of primary lung malignant tumors.At present,the diagnosis of PPL mainly depends on Cordier's diagnostic criteria,that is,imaging examination clearly showed that the tumor involved the lung and bronchus,but no hilar or mediastinal lymph node enlargement,no evidence of tumor in other parts of the lung and bronchus;no history of extrathoracic lymphoma,no signs of extrapulmonary lymphoma 3 months after onset.At present,the diagnosis and classification of PPL are mainly based on the differences of morphological and immunological characteristics between pathological cells and normal T cells and B cells.The pathological types of PPL are diverse,but MALT lymphoma is more common.Patients with different clinical manifestations,dispensable.The clinical manifestations of some patients can appear cough,expectoration,dyspnea,chest pain,fever and other symptoms,a few patients have no obvious symptoms,the reference value is limited.The imaging manifestations of PPL are various,including single or multiple nodules or masses,with uniform or uneven density.Some patients have patchy high-density shadow,which has no characteristic performance and is easy to be misdiagnosed.Previous case reports or cohort studies included a limited sample size;therefore,the understanding of the disease remains inadequate,and clinical data regarding PPL are limited.Therefore,we retrospectively analyzed the clinicopathological characteristics,treatment and prognosis of patients with ppl in our center,summarized the diagnosis and treatment experience,and discussed the possible predictive factors,so as to provide reference for future clinical diagnosis and treatment.MethodsPatients with PPL diagnosed histologically and radiologically between January 2000 and December 2019 at our center were retrospectively analyzed.The clinicopathological characteristics and prognostic factors of PLL were analyzed by gender,age,smoking,family history of tumor,initial symptoms,EOCG PS score,IPI,imaging findings,tumor location,histopathological results,clinical stage,LDH and ? 2-MG levels.The data in this study were analyzed by SPSS 23.0 and GraphPad Prism version 8.4.3.Categorical variables were compared by Pearson's chi-square test or Fisher's exact test.The continuous variables were tested by the Mann-Whitney U test or Student's t-test.The survival curves were estimated by the Kaplan-Meier method and compared with the log rank test.A Cox regression model was used to analyze the potential factors affecting survival.Two-sided P<0.05 was considered to indicate a significant difference.ResultsIn total,90 consecutive cases were included in this research.Forty-seven(52.2%)patients were female,and the median age was 54 years old.Non-Hodgkin's lymphoma(PPNHL)was the most common type of PPL(71/90,78.9%),and mucosa-associated lymphoid tissue(MALT)lymphoma was the most common pathological subtype of PPNHL(56.3%)followed by diffuse large B-cell lymphoma(DLBCL)(32.4%).Thirty-nine(43.3%)patients underwent surgical treatment,and the others received chemotherapy alone or combined with radiotherapy.The estimated 5-year overall survival(OS)rates of MALT lymphoma and non-MALT lymphoma were 68.9%and 65.9%,respectively.Univariate analysis of PPL showed that clinicopathological features that significantly correlated with worse OS were age over 60 years(P=0.006<0.05),elevated LDH(P=0.029<0.05)and ?2-MG(P=0.048<0.05)levels,clinical stage II2E and greater(P=0.015<0.05),and nonsurgical treatment(P=0.046<0.05).Age(P=0.013<0.05)was an independent prognostic factor for the 5-year OS of patients through multivariate analysis.ConclusionsAge over 60 years old,elevated LDH and ?2-MG levels,clinical stage II2E disease or higher,and nonsurgical treatment were associated with poor prognosis in patients with PPL.Age can be used as a potential independent prognostic factor for PPL. |
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