Correlation Analysis Of Some Inflammatory Indexes In Peripheral Blood And Prognosis Of Patients With Stage Ⅲ Squamous Lung Cancer

Objective: This study aimed to investigate the prognostic value of hemoglobin,albumin,lymphocyte and platelet(HALP)scores,systemic immune-inflammation index(SII),platelet-lymphocyte radio(NLR)on the prognosis of patients with stage Ⅲ squamous lung cancer treated by definitive radiotherapy(d RT)and the prognostic value effect of some combined indexes.Methods: Clinical data of stage Ⅲ squamous lung cancer patients who received d RT at the Radiotherapy Department of the Fourth Hospital of Hebei Medical University from January 2008 to December 2017 were retrospectively analyzed.The peripheral hematological indexes before radiotherapy were collected and recorded,and the inflammatory indexes including hemoglobin,albumin,lymphocyte and platelet score(HALP),systemic immune inflammation index(SII),and neutrophil to lymphocyte ratio(NLR)were calculated.X-Tile software was applied to determine the best cut-off values for continuous variables.SPSS25.0 software was used to compare the correlation between inflammatory indicators and clinicopathological features.Kaplan-Meier method was used to analyze Overall survival(OS)and Progression-free survival(PFS).Cox proportional hazards regression model was used for multivariate analysis.The predictive ability of HALP,SII and NLR for survival prognosis was compared by drawing the receiver operating characteristic(ROC)curve and calculating the area under the curve(AUC).Com-bination models were established to analyze the predictive value of HALP,SII and TNM stage combined into combined indicators for prognosis.The R software was used to establish a nomogram prediction model,and the Concordance Index(C-index)and calibration curve were used to evaluate the accuracy of the model.Results: A total of 453 patients were included in this study.All patients were followed up until November 30,2022,and 15 patients were lost to follow-up,with a follow-up rate of 96.7%.The median OS and 1,3,5,7-year OS rates were 22.9 months(95%CI: 20.616-25.184 months)and 73.7%,27.9%,18.2%,13.1%,respectively.The median PFS of the whole group was15.0 months(95%CI: 13.185-16.815 months).The 1,3,5,7-year PFS rates were 56.3%,21.6%,15.3%,11.8%,respectively.The optimal cut-off value of HALP was 46.4,and all patients were divided into low HALP group and high HALP group according to HALP < 44.1 and ≥44.1.In the low HALP group(<44.1),the median OS and 1,3,5,7-year OS rates were 20.8 months and71.3%,22.4%,12.1%,and 9.0%,respectively.The median OS and 1,3,5,7-year OS rates in the high HALP group(≥44.1)were 29.0 months and 81.5%,44.3%,31.2%,and 22.0%,respectively(χ2=18.708,P < 0.001).The median PFS and 1,3,5,and 7-year PFS rates in the low HALP group were 13.00 months and 52.4%,15.8%,10.7%,8.0%,respectively.The median PFS and 1,3,5,and 7-year PFS rates in the high HALP group were 21.00 months and68.5%,38.3%,28.3%,and 22.9%,respectively(χ2=17.866,P<0.001).Multivariate analysis showed that low HALP score was an independent risk factor for OS(HR=1.792,95%CI =1.363-2.355,P<0.001)and PFS(HR=1.793,95%CI =1.361-2.361,P<0.001).High SII score was also an independent risk factor for OS(HR=1.469,95%CI =1.156-1.868,P=0.002)and PFS(HR=1.366,95%CI =1.072-1.740,P=0.012).Independent risk factors for OS also included advanced TNM stage,no concurrent chemotherapy,and poor efficacy of radiotherapy.The independent risk factors for PFS were advanced TNM stage and poor radiotherapy efficacy.Correlation analysis showed that patients with high HALP were more likely to have low SII(P < 0.001)and low NLR(P < 0.001).There were significant differences in TNM stage between the low and high HALP groups(P=0.012,P=0.007,P=0.002).In addition,there were significant differences in drinking history(P=0.023)and radiotherapy efficacy(P=0.032)between the low and high HALP groups.The SII group was correlated with the efficacy of combined chemotherapy(P=0.013)and radiotherapy(P=0.021).NLR was associated with T stage(P=0.017)and radiotherapy response(P=0.015).By drawing the ROC curve and calculating the area under the curve(AUC),it was found that the AUC value of HALP in predicting survival(0.629)was better than SII(0.528)and NLR(0.518),and HALP had better prognostic prediction ability than SII and NLR.Further analysis of HALP,SII and TNM staging combined into the combined index showed that compared with HALP score alone,the three new combined indicators,The predictive power for survival prognosis was significantly increased(AUC of HALP,co HALP-TNM,co SII-TNM,co HALP-SII =0.568,0.588,0.593,0.601.A nomogram model for OS and PFS was established based on independent risk factors.The C-index was 0.665(95%CI=0.649-0.681)and 0.638(95%CI=0.622-0.654),respectively Calibration plots of OS and PFS at 1,3,5,and 7years showed good agreement between predicted and actual values.Conclusions:1.The peripheral blood inflammatory markers HALP,SII and NLR are related to the survival prognosis of patients with stage Ⅲ lung squamous cell carcinoma.HALP and SII are independent risk factors for OS and PFS,and HALP is better than SII and NLR in predicting the survival prognosis.2.The combination of HALP,SII and TNM stage in pairs is also an important indicator for predicting prognosis and survival.Patients in the high HALP group and the low SII group have the best prognosis.The predictive power of co HALP-TNM,co SII-TNM and HALP for survival prognosis decreased in turn.3.the nomogram prediction model based on HALP,SII and other clinicopathological features can accurately evaluate the survival of patients.