| Objective:Small cell lung cancer(SCLC)is a common type of lung cancer with high invasion and distant metastasis in common clinical tumors.It is easy to spread to the brain when the primary lesion invades and progresses.It has been recognized that the inflammatory microenvironment plays a key role in tumorigenesis and development.However,the relationship between inflammatory composite markers and prognosis in patients with SCLC brain metastases is poorly understood.This study will further explore the impact of hematologic inflammatory composite markers and clinical features on the prognosis of patients with SCLC.This study will be based on gender,age,smoking history,Eastern Cooperative Oncology Group(ECOG)performance status(PS)score,number of brain metastases,extracranial metastasis,pre-treatment hemoglobin(Hb)Content,pre-treatment serum lactate dehydrogenase(LDH)content,body mass index(BMI),pre-treatment peripheral blood systemic immune-inflammation index(SII),medium Neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR),prognostic nutrition index(PNI),interleukin(IL)-6 and The treatment mode(chemotherapy/chemotherapy combined with radiotherapy)and other clinical indicators to explore the prognostic factors of overall survival(OS)in patients with SCLC brain metastasis,in order to provide clinical prognostic clues.Methods:1.The study was divided into two parts.In the first part,the clinical data of 316 patients with early-stage SCLC with brain metastases from January 2008 to January 2017 were retrospectively analyzed.Record the patient’s gender,age,number of brain metastases,smoking history,presence or absence of extracranial metastases,ECOG PS score,hemoglobin(Hb)before treatment,serum lactate dehydrogenase(LDH),pre-treatment body Body Mass Index(BMI),systemic immune-inflammation index(SII),neutrophil to lymphocyte ratio(NLR),platelet-lymphocyte The ratio of platelet to lymphocyte ratio(PLR),prognostic nutrition index(PNI),treatment mode(chemotherapy/chemotherapy combined with radiotherapy)and 316 patients were followed up,and the patient’s OS was recorded on a monthly basis.The receiver operating characteristic curve(ROC)curve was used to determine the optimal cut-off value of inflammatory composite markers SII,NLR,PLR and PNI in patients with newly diagnosed SCLC brain metastases.Kaplan-Meier method,log-rank test,multi-factor analysis of prognosis of single-factor meaningful clinical indicators into COX proportional hazards model,and factors that have independent predictive effects on brain metastasis survival were screened.P < 0.05 was considered statistically significant.2.To further explore the influence of IL-6 on the prognosis of patients with SCLC and the clinical indicators including the composite index of inflammation,select the first part from January 2015 to January 2017.The initial treatment of SCLC patients with brain metastases,a total of 68 cases.Peripheral venous blood was collected from 68 patients in the morning.The blood samples were placed in heparin 2ml anticoagulant.IL-6 was detected by Th2 cytokine labeled flow cytometry.Using the normal median value of2.25% as the grouping criterion,we explored the prognostic impact of plasma IL-6 and its correlation with other indicators.Results:1.The median survival time of all patients was 11 months(9.63-12.37 months),with a range of 4-79.0 months.The 1-year,2-year and 3-year survival rates were 38.92%,12.66% and 5.4%,respectively.2.Kaplan-Meier univariate analysis(1)gender: male 258(81.65%);female 58(18.35%),P=0.305.(2)Age: 85(26.90%)cases >65 years old;231(73.10%)cases ≤65years old,P=0.014.(3)Smoking: smoking 241(76.27%);non-smoking 75(23.73%),P <0.001.(4)ECOG PS score: 0-1 points 269(85.13%)cases;2 points 47(14.87%)cases,P=0.005.(5)Number of brain metastases: 116 cases(36.71%)in single cases;200 cases(63.29%)cases in multiple cases,P=0.011.(6)There were no extracranial metastases:233(73.73%)with extracranial metastases and 83(26.27%)with no extracranial metastases,P<0.001.(7)BMI: <18.5,12(3.80%)cases;≥ 18.5,304(96.20%)cases,P=0.677.(8)Pre-treatment blood HGB: normal 284(89.87%);reduction 32(10.13%)(15.22%),P=0.032.(9)LDH before treatment: normal 218(68.99%)cases;90(28.48%)cases with an upper limit of 1 time but no more than 2 times;8(2.53%)cases with an upper limit of more than 2 times,P < 0.001.(10)Before treatment NLR: <2.68,145(45.89%),≥ 2.68,171(54.11%),P=0.002.(11)PLR before treatment: <140.23,129(40.82%);≥140.23,187(59.18%),P=0.004.(12)Before treatment SII: <968.50,229(72.47%)cases;≥968.50,87(27.53%)cases,P <0.001.(13)PNI before treatment: ≥52.60,162(51.27%),<52.60,154(48.73%),P<0.001.(14)Treatment mode: 66(20.89%)patients with chemotherapy alone;250(79.11%)patients with radiotherapy combined with P < 0.001.3.COX multivariate analysis: SII,PNI,serum LDH,extracranial metastasis,smoking history,PS score were closely related to the prognosis of patients with SCLC who were newly diagnosed with brain metastases,and were independent prognostic factors.4.Before treatment,IL-6: <2.25%,35(51.47%),median survival time was 14 months,≥2.25%,33(48.53%),median survival time was 8 months,P=0.033.IL-6 was not associated with gender,age,smoking,ECOG PS score,number of brain metastases,pre-treatment HGB,LDH,BMI,pre-treatment SII,NLR,PLR,PNI,and post-diagnosis treatment(P>0.05).Conclusions:1.In general clinical features,women with,ECOG PS score 0-1,single brain metastasis,no extracranial metastasis and non-smokers had a longer survival period.ECOG PS score 、smoking history and extracranial metastasis were independent prognostic factors.2.The level of LDH,HGB,SII,NLR and PLR were normal before treatment in laboratory hematology.The survival time of patients was longer when the ratio of PNI was higher than that of low,and the survival time of patients was longer when the ratio of PNI was higher.SII,PNI and LDH were independent prognostic factors.At the same time,we have also demonstrated that SII is superior to the independent marker of immuno-inflammation as an independent prognostic marker of immune inflammation.NLR,PLRand PNI.3.Patients with radiotherapy combined with treatment-related factors have a longer survival period.4.Patients with IL-6<2.25% accounted for 51.47%,and the prognosis was good.The median survival time was ≥2.25% for 6 months,P=0.033.5.IL-6 was not associated with inflammatory composite markers such as SII,NLR,PLR,PNI and clinical factors(P>0.05). |
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