The Predictive Value Of Creatinine To Cystatin C Ratio For Myelosuppression And Liver Toxicity After Chemotherapy In Lung Cancer

Objective:Lung cancer is the most common malignant tumor in the world with poor prognosis and survival quality in advantaged stages,occupying the leading place in cancer-related death.Chemotherapy is important in the treatment of small cell lung cancer and metaphase or advanced non-small cell lung cancer.The potential adverse reaction of chemotherapy,especially myelosuppression and liver toxicity,disturb the chemotherapy consistency and reduce the curative effect.Therefore,it has important clinical significance to study the potential risk factors of myelosuppression or liver toxicity after chemotherapy and apply clinical intervention early.These measures will reduce the occurrence of myelosuppression or liver toxicity and improve the prognosis of patients.In this study,we explored the potential risk-factors of myelosuppression and liver toxicity after chemotherapy in lung cancer patients,and investigated the relationship between Creatinine/CystatinC ratio and the occurrence risk of myelosuppression or liver toxicity after chemotherapy and evaluate its predictive value.Methods:We retrospectively analyzed the clinical data of 108 cases patients with lung cancer between January 2014 and January 2016 in the Qilu Hospital,mainly including patient name,age,sex,smoking history,imaging results,local or distant metastasis,chemotherapy regimens,surgery,postoperative pathologic results.The results of blood routine,hepatorenal function and blood biochemistry were collected one week and during chemotherapy.The patients with myelosuppression or abnormal liver function were case group,the others were control group,using single factor analysis method to explore the relationship between basic clinical features of patients and myelosuppression or abnormal liver function after chemotherapy.The patients were divided into low ratio group((R≤61.6033)),middle ratio group((61.6033<R<82.7990)),high ratio group(R>82.7990)according to the distribution of the AUC quarterback ratio of creatinine/cystatin C ratio.Single sample K-S tested normal distribution,chi-square test or Fisher’s exact test analysed risk factors of myelosuppression or abnormal liver function and the relationship with that ratio and assessed the predictive value of the ratio.SPSS 22 software was used for statistics and P<0.05 was considered statistically significant.Results:This study included 108 patients with lung cancer,including 67 cases of non-small cell lung cancer and 41 cases of small cell lung cancer.A total of 64 patients showed varying levels of myelosuppression,of which,48 were either 1 degree or 2 degrees of myelosuppression,which accounted for 75 percent of all patients with myelosuppression.Patients(<50 vs.50 or more,chi-square=8.918,P=0.003),gender(chi-square =5.980,P=5.980),blood albumin levels(chi-square=26.838,P=26.838),alcoholism(chi-square=5.137,P=5.137),the types of chemotherapy regimens in platinum(chi-square=10.180,P=10.180)were associated with myelosuppression after chemotherapy.By assessment of liver function during 4 periods of chemotherapy,58 patients(53.7%)show the different degree of abnormal liver function,38 patients were liver damage,and the others did not reach the level of liver function damage.In addition,79.3 percent of patients with abnormal liver function were level I abnormal liver function,without level IV abnormal liver function.The patients’ body mass index(BMI)(chi-square=5.747.P=0.017),the history of alcoholism(chi-square=20.145,P=0.000),clinical stages(chi-square=10.580,P=0.001)were statistically correlated with the abnormal liver function after chemotherapy.The ratio of creatinine/cystatin C was affected by serum HDL level(chi-square=6.402,P=0.046),albumin level(chi-square=7.329,P=0.023),and lung cancer clinical staging(chi-square=9.790,P=0.007).The ratio of creatinine/cystatin C was significantly associated with the risk of myelosuppression(chi-square= 10.662,P=0.005)and abnormal liver function(chi-square=13.258,P=0.001).the risk of myelosuppression and abnormal liver function were higher in the low ratio group(R≤61.6033)than in other groups.Conclusion:Myelosuppression or liver toxicity in patients with lung cancer are affected by the basic clinical features of patients.Serum HDL level,albumin level and clinical stage affect the ratio of creatinine/cystatin C.After chemotherapy,the incidence of myelosuppression or liver toxicity was higher in patients with low ratio of creatinine/cystatin C.Creatinine/cystatin C has the potential to predict myelosuppression and liver toxicity after chemotherapy.