目的:使用中性粒细胞与白蛋白比值(NAR)评估癌症患者的预后价值的实用性和有效性尚不清楚,需要进行研究以充分了解其在癌症人群中的潜在应用。
方法:采用Kaplan-Meier法进行生存分析,并采用对数秩检验进行比较。单变量和多变量Cox比例风险模型用于确定预后生物标志物,并进行Logistic回归分析,探讨NAR和90天结局与恶病质的关系。
结果:该研究包括14682名癌症患者,分为发现(6592名患者),内部验证(2820名患者),和外部验证组(5270例患者)。在发现中,高NAR患者的全因死亡率高于低NAR患者(50.15%对69.29%,P<0.001),内部验证(54.18%对70.91%,P<0.001),和外部验证队列(40.60%对66.68%,P<0.001)。在发现队列中,观察到高NAR与患者全因死亡率独立相关(HR1.16,95%CI1.12-1.19;P<0.001).此外,通过内部验证(HR1.21,95%CI1.16-1.27,P<0.001)和外部验证队列(HR1.27,95%CI1.21-1.34,P<0.001),我们验证了NAR作为癌症患者生存预测指标的前景价值.此外,在肿瘤类型的亚组分析中,高NAR被认为是大多数癌症的危险因素,除了乳腺癌.
结论:这项研究表明,NAR是预测癌症患者预后和癌症恶病质的可行且有前景的生物标志物。
OBJECTIVE: The practicality and effectiveness of using the prognostic value of the neutrophil-to-albumin ratio (NAR) in evaluating patients with cancer remain unclear, and research is needed to fully understand its potential application in the cancer population.
METHODS: The Kaplan-Meier method was used for survival analysis, and the log-rank test was employed for comparison. Univariate and multivariate Cox proportional hazards models were used to determine the prognostic biomarkers, and Logistic regression analysis was conducted to investigate the relationship between NAR and 90-day outcomes and cachexia.
RESULTS: The study included 14 682 patients with cancer, divided into discovery (6592 patients), internal validation (2820 patients), and external validation groups (5270 patients). Patients with high NAR had higher all-cause mortality than those with low NAR in the discovery (50.15% versus 69.29%, P < 0.001), internal validation (54.18% versus 70.91%, P < 0.001), and external validation cohorts (40.60% versus 66.68%, P < 0.001). In the discovery cohort, high NAR was observed to be independently associated with all-cause mortality in patients (HR 1.16, 95% CI 1.12-1.19; P < 0.001). Moreover, we validated the promising prognostic value of NAR as a predictor of survival in patients with cancer through internal validation (HR 1.21, 95% CI 1.16-1.27, P < 0.001) and external validation cohorts (HR 1.27, 95% CI 1.21-1.34, P < 0.001). Additionally, in the subgroup analysis by tumor type, high NAR was identified as a risk factor for most cancers, except for breast cancer.
CONCLUSIONS: This study showed that NAR is a feasible and promising biomarker for predicting prognosis and cancer cachexia in cancer patients.