Clinicopathological Characteristics And Prognosis Of Elderly Patients With Non-small Cell Lung Cancer

ObjectivesRetrospectively analyze(≥65 years old)the clinical and pathological characteristics of elderly NSCLC patients,and understand the individual,tumor and inflammation related factors that may affect the prognosis of patients.In order to provide detailed and reliable research data for future clinical work,and provide a reference for clinicians to comprehensively and accurately assess the prognosis of elderly patients with lung cancer.MethodsIn this study,257 elderly patients(≥65 years of age)who were diagnosed as primary NSCLC by histopathology at the Shaanxi Provincial Cancer Hospital from January 2016to December 2017 were selected as the research object.Check and record the patient’s gender,age,smoking index(SI),body mass index(BMI),ECOG score,lesion location,malignant pleural effusion(MPE),distant organ metastasis,TNM staging,histology type,degree of tumor differentiation,gene mutation status,and inflammation indicators and other clinical data.Calculate neutrophil-lymphocyte ratio(NLR),Platelet-lymphocyte ratio(PLR),systemic immune-inflammation index(SII)and other inflammatory composite indicators through peripheral blood neutrophils(NEUT),lymphocytes(LYM)and platelets(PLT).Follow-up was conducted by telephone,outpatient review,letters and visits,etc.At the same time,the follow-up information of the patient service center of our hospital was queried to obtain survival data.The follow-up deadline is December 31,2019.All case data were processed and analyzed using SPSS 25.0 statistical software.According to the ROC curve,determine the optimal cutoff value of the composite inflammation indicators(NLR,PLR,SII)to predict the patient’s overall survival(OS),and divide the patients into low and high groups according to the cutoff value.Use the life table method to estimate the 1-year and 2-year cumulative survival rates of the overall case data.The kaplan-Meier method was used for single-factor survival analysis.Log-rank test was used to evaluate survival difference,and survival function curve was drawn.The COX proportional hazards regression model analyzes statistically significant variables in university analysis to determine independent risk factors that affect prognosis.P<0.05 was considered statistically significant.Results1.Clinicopathological characteristicsA total of 257 elderly NSCLC patients met the inclusion criteria,with a sex ratio of3.15:1.The age range is 65~87 years old,and the high incidence age range is 65~75years old(72.0%,185/257).There were 161 cases(62.6%,161/257)with smoking history and 141 cases(87.6%,141/161)with"SI>400 cigarettes/year".29 cases(11.3%)in the low BMI(<18.5 kg/m~2)group,161 cases(62.6%)in the normal BMI(18.5~23.9 kg/m~2)group,and 67 cases(26.1%)in the high BMI(≥24.0 kg/m~2)group.There were 164 cases(63.8%)with ECOG score of 0 to 1,and 93 cases(36.2%)with≥2 points.The primary tumor was mostly located in the right lung(56.8%,146/257).60 patients(23.3%)had MPE at the time of treatment,and 85 patients(33.1%)had distant organ metastasis at the time of diagnosis.At the time of initial diagnosis,228 cases(88.7%)were in the middle-late stage(stage III-IV),and early stage(stage I-II)29 cases(11.3%).Adenocarcinoma is the main histological type(55.3%,142/257),followed by squamous cell carcinoma(40.9%,105/257).Tumor tissues are mostly poorly differentiated(grade III),accounting for 55.7%(143/257).In 113 cases of EGFR gene test,the mutation rate was 39.8%(45/113),with 19-del and 21-L858R mutations being the most common,and 1case of 20-S768I and 21-L861Q double mutation.According to the inflammatory composite indicators(NLR,PLR,SII)determined by the ROC curve,the best cutoff values for predicting the OS of patients are 3.99,106.23,and 787.28,respectively.2.Prognostic survival analysisAnalyzing the overall case data,the median survival time(MST)of 257 elderly NSCLC patients was 14.4 months,and the 1-year and 2-year cumulative survival rates were 66%and 31%,respectively.The results of single factor survival analysis show:Gender,age,BMI,lesion location,histological type,and EGFR mutation status have no significant effect on the prognosis of elderly NSCLC patients(P>0.05);SI,ECOG score,MPE,distant organ metastasis,TNM stage,tumor differentiation degree,Inflammation composite indicators(NLR,PLR,SII)were significantly correlated with the prognosis of elderly NSCLC patients(P<0.05).Multi-factor survival analysis results show:MPE,distant organ metastasis,TNM stage,Tumor differentiation degree and NLR are independent risk factors that affect OS in elderly NSCLC patients(P<0.05).Elderly NSCLC patients with MPE at the first diagnosis have a poorer prognosis,and the risk of death is 1.804 times that of patients without MPE;The risk of death of patients with distant organ metastases at the first diagnosis is 1.579times that of non-metastatic patients;The risk of death in patients with TNM stage in the middle and late stages(stage III-IV)is early(stage I-II)2.336 times of patients;The risk of death of patients with poorly differentiated tumors(grade III)is 1.888 times that of patients with high to moderate differentiation(grades I~II);Elderly NSCLC with a composite inflammation index"NLR≥3.99"has a higher risk of death,which is 1.974times that of patients with"NLR<3.99".Conclusions1.The elderly NSCLC in our center has a high sex ratio of men and women,with a high incidence age of 65~75 years old.The primary tumor is located in the right lung;The pathological type is most common with adenocarcinoma,and the tumor tissue cells are mostly poorly differentiated(gradeⅢ);at the time of diagnosis,it is mostly in the middle and late stages(stage III-IV),distant organ metastasis is more common in bone and brain;The EGFR gene is more common in 19-del and 21-L858R mutations,and there are joint mutations.2.Combined MPE,the presence of distant organ metastasis,late TNM staging,low differentiation of tumor tissue,and high NLR levels are closely related to the poor prognosis of elderly NSCLC patients.They are independent risk factors affecting the OS of patients and should be included in the clinical study of elderly NSCLC Design and treatment decision-making process.3.Compound inflammation indicators(NLR,PLR,SII)are expected to be effective predictors of the prognosis of elderly NSCLC patients,and are negatively correlated with the prognosis of patients.The higher the level at the time of initial diagnosis,the worse the prognosis;especially the detection of peripheral blood NLR the assessment of the prognostic risk of elderly NSCLC patients has a high value.