| Objective:To analyze the influence of the levels of systemic immune inflammation index(SII)and prognostic nutritional index(PNI)on the prognosis of patients with stage ⅢB-Ⅳ negative driver gene non-small cell lung cancer(NSCLC).Methods:the clinical data of 121 patients with stage ⅢB-Ⅳ driver gene negative NSCLC in our hospital from January 2017 to December 2019were retrospectively analyzed.The expression of Ki-67 in NSCLC tissues was detected by immunohistochemistry,and the corresponding data of 50 healthy people were collected.The levels of SII and PNI in peripheral blood of patients before treatment were compared with those of healthy people.The best cut-off values of SII and PNI were determined by receiver operating characteristic curve,and the relationship between Ki-67 expression level and peripheral blood SII and PNI,and the relationship between Ki-67 expression level and prognosis of NSCLC were analyzed.Spss24.0 software was used for statistical analysis.Results:1.The relationship between serum levels of SII,PNI,Ki-67 and Clinical biological characteristics before treatmentThe SII and PNI of 121 patients were(879.80±396.01)and(46.17±5.76)respectively.In the healthy control group,The SII and PNI were(720.17±333.05)and(48.39±4.78)respectively.The results showed that the SII of patients with ⅢB-Ⅳ stage NSCLC was significantly higher than that of healthy controls(t=2.506,P=0.013),and the PNI was significantly lower than that of healthy controls(t=-2.408,P=0.017).The optimal threshold values of SII and PNI in peripheral blood before treatment were defined by ROC curve as 730.98 and 44.68,respectively.According to the critical value,they were divided into high level group and low level group.Among them,58 cases of peripheral blood SII>730.98,63 cases of SII≤730.98,72cases of PNI>44.68,49cases of PNI≤44.68.The level of SII was correlated with stage(P=0.019),The higher the level of SII,the later the stage.There was no significant correlation between PNI and clinicopathological features before treatment(P>0.05)。The expression of Ki-67 was related to the stage of patients(P=0.030).The later the stage,the higher the expression level of Ki-67.Spearman correlation analysis showed that SII level was positively correlated with Ki-67 expression(P=0.05),PNI was negatively correlated with Ki-67 expression(P=0.019).Before treatment,SII was negatively correlated with PNI(P=0.016).2.The relationship between the SII,PNI and expression of Ki-67before treatment and the disease control rate(DCR)and prognosisThe disease control rate of 121 NSCLC patients with negative driving gene was 57.9%(70/121).The therapeutic effect of patients was related to the stage(X~2=4.863,P=0.027).The DCR of patients with ⅢB stage was significantly higher than that of patients with Ⅳ stage.The disease control rate of patients with high SII level was significantly lower than that of patients with low SII level before treatment,The difference was statistically significant(X~2=7.749,P=0.005).Before treatment,the DCR of patients with high PNI level was higher than that of patients with low PNI level,and the difference was statistically significant(X~2=18.11,P<0.001).The DCR of patients with high Ki-67expression was significantly lower than that of patients with low Ki-67expression.(X~2=6.719,P=0.010)。Logistic regression analysis showed that PNI level Before treatment is an independent prognostic factor in NSCLC patients with negative driving gene(P<0.001).The median PFS was17.5 months in NSCLC patients with negative driving gene.Before treatment,29 patients with SII>730.98 progressed,the median PFS was 23.4 months,17 patients with SII≤730.98progressed,and the median PFS was 13.5 months.The higher level of SII was significantly prolonged in patients with low level of SII(X~2=11.4,P=0.01).20 patients with PNI>44.68 progressed,the median PFS was 20.4 months,and 26 patients with PNI≤44.68 progressed,The median PFS was 12.5 months.The PFS was significantly prolonged in patients with high PNI level(X~2=14.62,P<0.001).The median PFS was18.3 months in 15 patients with Ki-67≤25%and 14.7 months in 31patients with Ki-67>25%.The PFS was significantly prolonged in patients with low Ki-67 expression and patients with high Ki-67expression(X~2=4.450,P=0.03).Before treatment,26 patients died with SII>730.98,and the median OS was 20.7 months.13 patients died with SII≤730.98,and the median OS was 37.2 months.In patients with low level of SII,the OS of higher level of SII was significantly prolonged(X~2=16.82,P<0.001).In patients with PNI>44.68,18 patients died,and the median OS was 37.2 months,21 patients with PNI≤44.68 died,and the median OS was 20.7 months.It suggested that OS was significantly prolonged in patients with high PNI level(X~2=8.977,P=0.003).7 patients with Ki-67≤25%died,the median OS was 37.2 months,32 patients with Ki-67>25%progressed,and the median OS was 23.8 months.The OS of patients with low Ki-67 expression was significantly longer than that of patients with high Ki-67 expression(X~2=5.026,P=0.025).Univariate analysis showed that ECOG score,TNM stage,pre-treatment SII,pre-treatment PNI and Ki-67 expression were correlated with PFS(P<0.05),but not with gender,age,pathological type,smoking history,treatment mode,radiation dose and metastasis.(P>0.05).Gender,TNM stage,multiple metastasis,pre-treatment SII,pre-treatment PNI,Ki-67 expression were significantly correlated with OS(P<0.05).Cox multivariate analysis showed that ECOG score,pre-treatment SII,pre-treatment PNI level were independent risk factors for PFS;gender,metastasis,pre-treatment SII,pre-treatment PNI level were independent prognostic factors for OS.3.The relationship between peripheral blood SII,PNI and Ki-67expression in and prognosisPairwise comparison showed that PFS and OS of patients with low SII+high PNI level before treatment were significantly prolonged in patients with high SII+low PNI level group(c2=24.855,P<0.001;c2=19.23,P<0.001).PFS and OS in high PNI+low Ki-67 expression group were significantly longer than those in low PNI+high Ki-67expression group(X~2=6.850,P=0.009,c2=5.622,P=0.018).PFS and OS in low SII+low Ki-67 expression group were significantly longer than those in high SII+high Ki-67 expression group,the difference was statistically significant(X~2=9.535,P=0.002;X~2=14.620,P<0.001).Conclusions:1.In patients with stage ⅢB-Ⅳ drive gene negative NSCLC,the level of peripheral blood SII was significantly higher than that of healthy people,and the level of peripheral blood PNI was significantly lower than that of healthy people.Patients with stage ⅢB-Ⅳ driver gene negative NSCLC with high level of SII,low level of PNI and high expression of Ki-67 have poor prognosis.2.Combined detection of peripheral blood SII、PNI and Ki-67expression in cancer tissue can predict the prognosis of NSCLC with negative ⅢB-Ⅳ driver gene. |
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