肺部免疫预后指数联合血清sTNFR2对非小细胞肺癌患者化疗并发骨髓抑制的预测价值OA

Objective To explore the predictive value of the lung immune prognostic index(LIPI)combined with serum soluble tumor necrosis factor receptor 2(sTNFR2)for bone marrow suppression complicated by chemotherapy in pa-tients with non-small cell lung cancer(NSCLC).Methods A total of 92 patients with NSCLC who received chemotherapy were included and divided into a myelosuppression group(63 cases)and a non-myelosuppression group(29 cases)according to whether myelosuppression occurred after chemotherapy.Fasting venous blood was collected from all patients within 24 hours of admission.Absolute neutrophil count(Neu),total white blood cell count(WBC),and lactate dehydrogenase(LDH)were detected by an automatic analyzer.The derived neutrophil-to-lymphocyte ratio(dNLR=Neu/(WBC-Neu))was calculat-ed,and the LIPI score was evaluated according to the modified criteria.Serum sTNFR2 levels were detected by ELISA.The t-test/Wilcoxon rank sum test and x2 test were used to compare baseline indicators between the two groups.Multivariate logis-tic regression analysis was used to identify independent risk factors.ROC curves were used to evaluate predictive efficacy.Re-sults Serum sTNFR2 level in the myelosuppression group was(2.41±0.76)ng/mL,which was significantly higher than that in the non-myelosuppression group[(1.45±0.52)ng/mL](t=6.235,P＜0.001).LIPI-related indicators(dNLR,Neu,WBC,LDH),sTNFR2,ALT,and Cr in the myelosuppression group were all significantly higher than those in the non-myelosuppres-sion group(t=5.873,4.592,3.586,5.012,6.235,2.648,2.715,all P＜0.001).High LIPI score,high serum sTNFR2,and plati-num-based dual-drug chemotherapy regimens were independent risk factors for bone marrow suppression complicated by chemotherapy in NSCLC patients[OR(95％CI)=2.518(1.423-4.451),1.852(1.236-2.778),2.689(1.215-5.947);P=0.002,0.003,0.015].The AUCs of LIPI,serum sTNFR2,and their combination in predicting bone marrow suppression complicated by chemotherapy in NSCLC patients were 0.775,0.816,and 0.903,respectively.The combined predictive efficacy of the two was superior to that of each individual(differences were compared using the DeLong method)(Z=2.345,1.987;P=0.019,0.047).Conclusion The LIPI score combined with serum sTNFR2 can effectively enhance the predictive efficacy of bone marrow suppression during chemotherapy in NSCLC patients,providing a precise basis for clinical risk stratification.