治疗前HALP评分对Ⅳ期无驱动基因NSCLC患者的预后意义

目的:探究Ⅳ期无驱动基因非小细胞肺癌(non-small cell lung cancer,NSCLC)患者治疗前血红蛋白、白蛋白水平、淋巴细胞和血小板计数（HALP）联合检测的预后意义。方法:回顾性分析我院167例2017年3月-2019年12月符合入组标准的NSCLC患者临床病理资料。利用X-Tiles软件计算出HALP评分的最佳临界值，将患者分为低HALP组与高HALP组；应用Kaplan-Meier方法进行生存分析,单因素和Cox多因素分析确定与无进展生存期(progression-free survival,PFS)相关的因素。结果:通过X-Tiles软件确定HALP评分的最佳临界值为27.7，低HALP组（＜27.7）70例，高HALP组（≥27.7）97例，HALP值与患者的BMI，KPS评分，T分期，远处转移，化疗疗程数，贫血与否，白蛋白值的组间差异有统计学意义（均P＜0.05），而在性别，年龄，吸烟与否，病理类型,N分期的组间无显著差异（P＞0.05）。患者治疗后治疗获益(disease control rate,DCR)组和疾病进展(progressive disease,PD)组的HALP评分具有明显差异（P＜0.05），低HALP组与高HALP组的中位PFS时间差异有统计学意义（5个月vs 7个月，P=0.003）。单因素分析显示KPS评分、BMI、T分期、N分期、远处转移、化疗疗程数、治疗前HALP评分、白蛋白值、贫血与否是患者预后的影响因素（P＜0.05）。多因素分析可见KPS评分、T分期、远处转移、化疗疗程数、治疗前HALP评分、白蛋白值、贫血与否是独立危险因素（P＜0.05）。结论:在接受化疗联合恩度的Ⅳ期驱动基因阴性的非小细胞肺癌患者中，HALP评分对疗效及预后有一定的预测作用，低水平的HALP值可能提示非小细胞肺癌预后差。

Prognostic significance of the pre-treatment HALP score in patients with stage IV non-small cell lung cancer without a driver gene

Objective:To investigate the prognostic significance of the novel index combining pre-treatment hemoglobin and albumin levels and lymphocyte and platelet counts (HALP) in patiants with stage IV non-small cell lung cancer (NSCLC)without a driver gene.Methods:Clinical and pathological data of 167 NSCLC patients who met the inclusion criteria from March 2017 to December 2019 in our hospital were retrospectively analyzed.The optimal cut-off values of the HALP score was determined by X-tile software.The patients were divided into the group with low HALP score and the group with high HALP score.Kaplan-Meier method was used for survival analysis.Univariate and Cox multivariate analysis were used to identify the factors associated with progression-free survival(PFS).Results:The optimal cut-off values of the HALP score was determined by X-tile software to be 27.7.70 patients in the low HALP group (<27.7) and 97 patients in the high HALP group (≥27.7).HALP was associated with BMI,KPS score,T stage,distant metastases,number of chemotherapy,anemia or not and albumin values (all P＜0.05).while there were no significant differences among groups in patients' gender,age,smoking or not,pathological type and N stage(P＞0.05).There were statistically significant differences in HALP score between the disease control rate (DCR) group and the progressive disease (PD) group after chemotherapy (P＜0.05).There was a statistically significant difference in median PFS time between the low HALP group and the high HALP group (5 months vs 7 months,P=0.003).Univariate analysis showed that BMI,KPS score,T stage,N stage,distant metastases,number of chemotherapy,anemia or not,albumin values,the HALP score before treatment were influential factors for prognosis (P＜0.05).According to the multivariate analysis,KPS score,T stage,distant metastases,number of chemotherapy,anemia or not,albumin values,the HALP score before treatment were independent risk factors for prognosis (P＜0.05).Conclusion:In stage Ⅳ NSCLC without a driver gene patients undergoing chemotherapy combined with endostatin,the HALP score has a certain predictive significance on the efficacy and prognosis,low levels of HALP score may be a significant risk factor for PFS in NSCLC patients.