| PurposeSmall-cell lung cancer(SCLC)is a pathological type with poor prognosis in lung cancer.The current study aimed to look for markers of disease control and survival prediction in the hematological test indicators before SCLC treatment and establish a nomogram model to predict the survival of SCLC patients intuitively and visually.MethodA retrospective analysis of 234 SCLC patients admitted to the Affiliated Hospital of Qingdao University from January 2013 to August 31,2018 enrolled in our study.The clinical pathology,treatment characteristics,and hematological indices before treatment were collected through the electronic case system—a descriptive analysis of the patient's clinicopathology and treatment characteristics.The optimal cutoff value of continuous variable peripheral blood lymphocytes(TLC),platelets,D-dimer,lactate dehydrogenase(LDH),carcinoembryonic antigen(CEA),neuron-specific enolase(NSE)counts and neutrophil-to-lymphocyte ratio(NLR)and platelet-to-lymphocyte ratio(PLR)were decided through the Roc curve.Univariate analysis was conducted by the Kaplan-Meier method,and variables with statistical significance in univariate analysis were included in the COX proportional hazard model for multivariate survival analysis.According to COX regression coefficients,the Nomogram(column diagram)of predicted survival was drawn and verified by R software.P <0.05 means the difference was statistically significant.Result1.The median progression-free survival(PFS)and median survival(OS)of SCLC patients were 9.590 months and 18.721 months,respectively.Smoking history,disease stage,liver metastasis,brain metastasis,bone metastasis,number of first-line chemotherapy cycles,thoracic radiotherapy,NLR,LDH,NSE,and CEA were closely correlated to PFS in the univariate analysis.Multivariate analysis found the history of smoking history(P = 0.006),chest radiotherapy(P = 0.027),the number of first-line chemotherapy cycles(P = 0.002),and lactate deprivation before treatment LDH(P = 0.001)were independent prognostic factors for PFS in SCLC patients.Univariate analysis found KPS score,gender,age,stage,liver metastasis,brain metastasis,bone metastasis,thoracic radiotherapy,hyponatremia,NLR,LDH,and NSE were closely related to the patient's OS.Multivariate analysis of the COX proportional hazards model showed that age(P = 0.014),stage(P = 0.009),KPS score(P = 0.004),chest radiotherapy(P = 0.026)and LDH(P = 0.018)were independent prognostic factors of OS.2.Pretreatment serum LDH was an important hematological marker for predicting the prognosis of SCLC.The median PFS were 10.770(95% CI,9.154-12.386)months and 9.000(95CI,8.006-9.934)months(P =0.001).The median OS of patients with LDH?215.7 U/L and LDH <215.7U /L before treatment was 21.279(95% CI,17.631-24.927)months and 16.131(95% CI,14.239-18.024)months(P=0.018).The differences between the two groups were distinct.3.The factors that influenced survival were imported into construct nomograms by R software.The C-indexes of our nomogram were 0.638(PFS)and 0.669(OS).ConclusionSerum LDH before treatment,smoking history,thoracic radiotherapy,number of firstline chemotherapy cycles,and are independent prognostic factors for PFS.Serum LDH before treatment,stage,age,KPS score,thoracic radiotherapy,and are independent prognostic factors for OS in patients with SCLC.The LDH is an important factor for predicting OS and PFS.In clinical treatment of SCLC,LDH may have an important parameter contributing to treatment decisions. |
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