腰高比与肺腺癌患者术后化疗粒细胞减少的相关性研究

Study on the Correlation between Waist-to-Height Ratio and Neutropenia after Chemotherapy in Patients with Lung Adenocarcinoma

摘要: 目的：探讨腰高比(waist-to-height ratio, WHtR)与肺腺癌患者术后接受顺铂 + 培美曲塞方案辅助化疗所致粒细胞减少的相关性。方法：回顾性连续纳入300例肺腺癌术后接受顺铂 + 培美曲塞方案辅助化疗的腺癌患者(IIA~IIIB期)。测量化疗前身高、体重、腰围，并计算腰高比(WHtR)、BMI等。依据WHtR是否≥0.5将患者分为高WHtR组和低WHtR组。主要结局指标为化疗期间≥3级粒细胞减少的发生率。使用Log-rank检验进行组间比较，Kaplan-Meier法绘制粒细胞减少的累积发生率曲线，采用多因素COX回归模型分析WHtR与粒细胞减少的独立关联。结果：300例患者中，共72例(24.0%)发生粒细胞减少。低WHtR组粒细胞减少发生率为34.8%，高WHtR组为11.5%，差异有统计学意义。多因素COX回归显示，WHtR是粒细胞减少的独立保护因素(作为连续变量时：HR < 0.001，95% CI: 0.000~0.001，P < 0.001；作为二分类变量时：HR = 0.279，95% CI: 0.160~0.486，P < 0.001)。结论：WHtR与肺腺癌患者术后顺铂 + 培美曲塞化疗所致粒细胞减少相关，WHtR作为一种简便、无创的人体测量指标，可成为化疗前的风险评估工具。

Abstract: Objective: To investigate the correlation between waist-to-height ratio (WHtR) and granulocytopenia induced by cisplatin plus pemetrexed adjuvant chemotherapy in patients with lung adenocarcinoma postoperatively. Method: A retrospective study consecutively enrolled 300 patients with lung adenocarcinoma (stages IA-IB) who received adjuvant chemotherapy with cisplatin plus pemetrexed postoperatively. Pre-treatment measurements of height, weight, and waist circumference were recorded, and parameters such as waist-to-height ratio (WHtR) and body mass index (BMI) were calculated. Patients were classified into a high WHtR group and a low WHtR group based on whether their WHtR was ≥0.5. The primary outcome measure was the incidence of grade ≥3 granulocytopenia during chemotherapy. Intergroup comparisons were performed using the Log-rank test; cumulative incidence curves for granulocytopenia were plotted using the Kaplan-Meier method; and a multivariate Cox regression model was employed to analyze the independent association between WHtR and granulocytopenia. Results: Among the 300 patients, granulocytopenia occurred in 72 cases (24.0%). The incidence of granulocytopenia was 34.8% in the low WHtR group and 11.5% in the high WHtR group, with a statistically significant difference. Multivariate COX regression analysis demonstrated that WHtR was an independent protective factor for granulocytopenia (as a continuous variable: HR < 0.001, 95% CI: 0.000~0.001, P < 0.001; as a binary variable: HR = 0.279, 95% CI: 0.160~0.486, P <0.001). Conclusion: WHtR exhibits a significant negative correlation with neutropenia induced by cisplatin plus pemetrexed chemotherapy in lung adenocarcinoma patients postoperatively. As a simple and non-invasive anthropometric parameter, WHtR can serve as a risk assessment tool prior to chemotherapy.