The Effect Of Prognostic Nutritional Index On The Prognosis Of Small Cell Lung Cancer

Objective:By collecting the small cell lung cancer(SCLC)patients with gender,age,smoking index,condition of hydrothorax,clinical stage,treatment and hematological indicators before they were treated,such as blood routine examination and biochemical test,our survey was to explore the clinical value of prognostic nutritional index(PNI)for patients with SCLC in evaluating the prognosis of the SCLC patients'over survival(OS).Looking forward to scientific theoretical guidance for the individualized comprehensive treatment of SCLC.Methods:From October 2013 to May 2018,the clinical data from 261 cases of SCLC patients who were diagnosed at the Affiliated Hospital of Chengde Medical College were retrospectively analyzed.The general data of the study subjects(gender,age,smoking index,with or without hydrothorax,clinical stage,treatment)were collected.The blood routine examination(hemoglobin,lymphocytes count)and biochemical test(serum albumin level)of subjects before treatment were also collected.All the patients'over survival were followed-up by telephone,outpatient review,etc.The PNI was calculated as:serum albumin(g/L)+5×lymphocyte count(10~9/L).According to Veterans Administration Lung Study Group(VALSG),the SCLC patients were divided into limited disease(LD)and extensive disease(ED).We applied SPSS 23.0 statistical software for statistical analysis.The receiver operating characteristic(ROC)curve was drawn to determine the optimal cut-off value of PNI.The patients with SCLC were divided into two groups to investigate the relationship with prognosis according to the PNI values.The survival curves of patients with different characteristics were produced by Kaplan-Meier method.Wilcoxon rank sum test or Kruskal-Wallis H test of multiple samples were used to compare the difference of OS between different groups.Survival rates were compared using log-rank The univariate and multivariate prognostic analysis were performed by the Cox proportional hazards model.P<0.05 was considered to represent a statistical difference.Results:1.A total of 261 SCLC patients were included in this study,factors affecting the analysis included age,gender,smoking history,with or without hydrothorax,clinical stage,treatment,PNI,HGB,and follow-up OS of patients.The overall median OS was calculated to be 15 months(95%CI:17.46 to 21.26).According to different clinical stages,the 1year survival rate and 2 years survival rate of LD patients were 72.84%and 29.63%,respectively.The 1 year survival rate and 2 years survival rate of ED patients were 56.67%and 23.89%,respectively.2.The ROC curves were drawn for PNI.The best cutoff points for the PNI were 48.9.The SCLC patients were divided into two groups to investigate the relationship with prognosis according to the PNI values..According to the chi-square test,PNI was related to the age,sex,and treatment and HGB(P<0.05),and was not related to the clinical stage and smoking index(P>0.05).Patients with high PNI group had a higher proportion of<58 years,women,chemotherapy+radiotherapy and high HGB.3.Univariate analysis of PNI,HGB and other factors affecting the prognosis of 261 SCLC patients,including age,gender,smoking index,with or without pleural effusion,clinical stage,and treatment was applied by Cox proportional hazard model.Gender,smoking index,clinical stage,treatment,HGB,PNI,were the prognostic factors of SCLC patients(P<0.05);then the statistically significant factors were included in the Cox regression;Clinical stage,treatment,HGB,PNI,are independent factors affecting the prognosis of SCLC patients.Conclusion:1.Smoking index,clinical stage,treatment,HGB level,PNI were independent risk factors for the prognosis of patients with SCLC,the difference was statistically significant(P<0.05);HGB level and PNI are common clinical hematological index,can be used as the prognostic indicators of SCLC patients Above prognostic indicators could guide the clinical individualized treatment,prolong the survival time of patients,and improve the quality of life of patients.2.Patients with low PNI and low HGB,who had worse prognosis than the patients with higher PNI,high HGB.PNI and HGB were independent risk factors for the prognosis of SCLC patients.PNI,as an indicator of the degree of inflammatory response and immune status in the body,could be used as a reference for predicting the prognosis of patients with SCLC.and would be used in clinic widely.