LANR和RDW在一线含铂化疗NSCLC预后评估中的作用

The Role of LANR and RDW in Prognostic Assessment of First-Line Platinum-Based Chemotherapy in NSCLC

摘要: 目的：探讨淋巴细胞–白蛋白–中性粒细胞指数(Lymphocyte Albumin Neutrophil Ratio, LANR)和红细胞分布宽度(Red Cell Distribution Width, RDW)在一线含铂化疗非小细胞肺癌(Non-Small Cell Lung Cancer, NSCLC)预后的预测价值。方法：选取2020年1月至2024年5月在安徽医科大学第四附属医院接受一线含铂化疗的132例NSCLC患者。通过受试者工作特征(Receiver 0perating Characteristic, ROC)曲线确定LANR、RDW的最佳截断值进行分组，并分析组间差异；用Kaplan-Meier法分析患者的无进展生存期(Progression-Free Survival, PFS)；多因素COX回归分析预后的影响因素；最后ROC曲线分析各指标预测效能。结果：LANR、RDW的曲线下面积(AUC)分别为0.663 (95% CI: 0.538~0.788)和0.713 (95% CI: 0.593~0.832)。高LANR组(LANR ≥ 15.36)和低LANR组(LANR < 15.36)在性别、病理分型、T期和治疗结果方面，组间差异有统计学意义(P < 0.05)。高RDW组(RDW ≥ 13.15)和低RDW组(RDW < 13.15)在年龄、病理分型、T期和治疗结果方面，组间差异有统计学意义(P < 0.05)。多因素分析显示远处转移、LANR和RDW是NSCLC患者预后的独立因素(均P < 0.05)。Kaplan-Meier生存分析显示低LANR组、高RDW组的中位PFS分别为5.7月和4.2月，明显短于高LANR组、低RDW组的11.4月和11.8月(P < 0.05)；构建的LANR-RDW评分与患者的PFS呈正相关。此外，LANR、RDW和LANR-RDW评分的AUC分别为0.663，0.713，0.777，LANR-RDW评分的AUC值最大。结论：LANR和RDW是一线含铂化疗NSCLC患者有效的预后指标，低LANR和高RDW提示预后不良；LANR-RDW评分预测预后的效能优于单一指标(LANR或RDW)。

Abstract: Aim: To investigate the prognostic value of the lymphocyte albumin neutrophil ratio (LANR) and red cell distribution width (RDW) in patients with non-small cell lung cancer (NSCLC) receiving first-line platinum-based chemotherapy. Methods: A total of 132 patients with NSCLC who received first-line platinum-based chemotherapy at the Fourth Affiliated Hospital of Anhui Medical University between January 2020 and May 2024 were retrospectively enrolled. The optimal cut-off values for LANR and RDW were determined using receiver operating characteristic (ROC) curve analysis, and patients were stratified accordingly. The progression-free survival (PFS) of patients was analyzed using the Kaplan-Meier method. Multivariate Cox regression analysis was conducted to explore the prognostic factors. Finally, receiver operating characteristic (ROC) curve analysis was performed to assess the predictive efficacy of each indicator. Results: The AUC values of LANR and RDW for predicting PFS were 0.663 (95% CI: 0.538~0.788) and 0.713 (95% CI: 0.593~0.832), respectively. Patients in the high-LANR group (LANR ≥ 15.36) and low-LANR group (LANR < 15.36) showed significant differences in sex, histological type, T stage, and treatment response (all P < 0.05). Similarly, the high-RDW group (RDW ≥ 13.15) and low-RDW group (RDW < 13.15) differed significantly in age, histological type, T stage, and treatment response (all P < 0.05). Multivariate analysis identified distant metastasis, LANR, and RDW as independent prognostic factors for NSCLC patients (all P < 0.05). Kaplan-Meier survival analysis revealed that patients in the low-LANR group had a median PFS of 5.7 months, significantly shorter than 11.4 months in the high-LANR group (P < 0.05). Likewise, the high-RDW group exhibited a median PFS of 4.2 months, markedly inferior to 11.8 months in the low-RDW group (P < 0.05). A combined LANR-RDW scoring system was constructed, and this score was positively correlated with PFS. The AUC values for LANR, RDW, and the LANR-RDW score were 0.663, 0.713, and 0.777, respectively, with the combined score demonstrating the highest predictive efficacy. Conclusion: Both LANR and RDW are effective prognostic biomarkers in NSCLC patients treated with first-line platinum-based chemotherapy. Low LANR and high RDW are independently associated with poor survival outcomes. The LANR-RDW score demonstrates superior predictive performance for prognosis compared to either single indicator (LANR or RDW).