Correlation between serum cystatin C and uric acid levels and prognosis of small cell lung cancer

doi:10.3760/cma.j.cn371439-20200728-00004

Abstract

Abstract:

Objective To explore the effects of serum cystatin C (Cys C) and uric acid (UA) concentrations before treatment on the prognosis of small cell lung cancer (SCLC) patients. Methods A total of 196 patients diagnosed with SCLC in Affiliated Hospital of Qingdao University from April 2015 to December 2018 were selected, and hematological indicators such as serum Cys C and UA before treatment were collected. The receiver operating characteristic (ROC) curve was used to determine the optimal cut-off values of Cys C and UA. The Kaplan-Meier method was used for survival analysis. Cox proportional hazards model was used for univariate and multivariate analysis. Results The optimal cut-off values of serum Cys C and UA before treatment were 0.775 mg/L and 296.45 μmol/L, respectively. Survival analysis showed that with the optimal cut-off value, the median progression-free survival (PFS) of patients with high concentrations of serum Cys C and UA (5.49 months vs. 8.57 months, χ²=35.943, P<0.001; 6.67 months vs. 8.20 months, χ²=8.047, P=0.005) and overall survival (OS) (13.37 months vs. 23.95 months, χ²=21.355, P<0.001; 14.13 months vs. 20.97 months, χ²=11.333, P=0.001) were shorter than those of patients with low concentrations. Univariate analysis showed that factors related to PFS were smoking history (HR=0.707, 95%CI: 0.518-0.965, P=0.029), staging (HR=1.776, 95%CI: 1.329-2.373, P<0.001), first-line medication (HR=1.596, 95%CI: 1.072-2.376, P=0.021), chest radiotherapy (HR=2.407, 95%CI: 1.803-3.214, P<0.001), Cys C (HR=3.602, 95%CI: 1.716-7.561, P=0.001), UA (HR=1.002, 95%CI: 1.000-1.003, P=0.036), and alkaline phosphatase (HR=1.010, 95%CI: 1.004-1.016, P=0.001); factors related to OS included smoking history (HR=0.577, 95%CI: 0.382-0.870, P=0.009), staging (HR=1.846, 95%CI: 1.295-2.630, P=0.001), chest radiotherapy (HR=2.041, 95%CI: 1.426-2.921, P<0.001), Cys C (HR=9.506, 95%CI: 3.278-27.564, P<0.001) and UA (HR=1.003, 95%CI: 1.001-1.005, P=0.006). Multivariate analysis showed that chest radiotherapy (HR=2.553, 95%CI: 1.774-3.672, P<0.001), Cys C (HR=4.538, 95%CI: 1.875-10.982, P=0.001) and alkaline phosphatase (HR=1.011, 95%CI: 1.005-1.018, P=0.001) were independent prognostic factors for PFS; Cys C (HR=9.028, 95%CI: 2.680-30.413, P<0.001) was an independent prognostic factor for OS. Conclusion Both serum Cys C and UA concentrations before treatment in SCLC patients have a certain relationship with the prognosis of the patients. Those with elevated concentrations have shorter PFS and OS and poor prognosis. The high concentration of serum Cys C before treatment may indicate a rapid progression of the disease and a short survival time. It is necessary to pay attention to disease progression and recurrence.

Key words: Small cell lung carcinoma, Prognosis, Cystatin C, Uric acid

Wang Haocheng, Dong Ya, Shan Dongfeng, Yu Zhuang. Correlation between serum cystatin C and uric acid levels and prognosis of small cell lung cancer[J]. Journal of International Oncology, 2021, 48(1): 24-29.

Figures/Tables 7

References 16

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临床病理特征	例(%)/中位数(范围)
性别
男	154(78.57)
女	42(21.43)
年龄(岁)
<60	83(42.35)
≥60	113(57.65)
吸烟史
有	139(70.92)
无	57(29.08)
ECOG评分
0	112(57.14)
1	84(42.86)
原发部位
右肺	119(60.71)
左肺	77(39.29)
分期
局限期	100(51.02)
广泛期	96(48.98)
一线化疗用药
依托泊苷联合铂类	166(84.69)
伊立替康联合铂类	30(15.31)
胸部放疗
有	102(52.04)
无	94(47.96)
胱抑素C(mg/L)^a	0.78(0.34~1.77)
尿酸(μmol/L)	285.00(77.30~579.00)
尿素氮(mmol/L)	5.07(1.53~11.77)
肌酐(μmol/L)	80.00(31.00~126.10)
碱性磷酸酶(U/L)	75.52(38.00~248.67)
腺苷脱氨酶(U/L)	10.00(2.00~26.00)
NLR	2.43(0.56~20.94)
PLR	158.74(55.21~521.19)

因素	PFS				OS
因素	HR值	95%CI	P值		HR值	95%CI	P值
性别(男 vs. 女)	0.724	0.514~1.020	0.065	0.693		0.450~1.070	0.098
年龄(<60岁 vs. ≥60岁)	1.122	0.843~1.494	0.431	0.960		0.675~1.367	0.822
吸烟史(有 vs. 无)	0.707	0.518~0.965	0.029	0.577		0.382~0.870	0.009
ECOG评分(0 vs. 1)	1.075	0.809~1.429	0.618	1.072		0.752~1.529	0.700
原发部位(右肺 vs. 左肺)	1.118	0.839~1.491	0.446	0.774		0.537~1.115	0.169
分期(局限期 vs.广泛期)	1.776	1.329~2.373	<0.001	1.846		1.295~2.630	0.001
因素	PFS				OS
因素	HR值	95%CI	P值		HR值	95%CI	P值
一线化疗用药(依托泊苷 vs. 伊立替康)	1.596	1.072~2.376	0.021	1.401		0.868~2.263	0.168
胸部放疗(有 vs. 无)	2.407	1.803~3.214	<0.001	2.041		1.426~2.921	<0.001
胱抑素C	3.602	1.716~7.561	0.001	9.506		3.278~27.564	<0.001
尿酸	1.002	1.000~1.003	0.036	1.003		1.001~1.005	0.006
尿素氮	1.000	1.000~1.000	0.959	1.000		1.000~1.001	0.280
肌酐	1.000	0.991~1.010	0.927	1.007		0.994~1.019	0.280
碱性磷酸酶	1.010	1.004~1.016	0.001	1.003		0.997~1.009	0.346
腺苷脱氨酶	1.023	0.984~1063	0.248	1.028		0.983~1.075	0.227
NLR	1.002	0.955~1.052	0.922	1.022		0.964~1.084	0.458
PLR	1.000	0.999~1.001	0.409	1.000		0.999~1.002	0.715

因素	PFS				OS
因素	HR值	95%CI	P值		HR值	95%CI	P值
吸烟史(有 vs.无)	0.699	0.471~1.035	0.074	0.751		0.435~1.296	0.303
分期(局限期 vs. 广泛期)	1.106	0.756~1.619	0.604	1.418		0.884~2.275	0.147
一线化疗用药(依托泊苷 vs. 伊立替康)	0.969	0.602~1.559	0.897	—		—	—
胸部放疗(有 vs. 无)	2.553	1.774~3.672	<0.001	1.474		0.910~2.387	0.115
胱抑素C	4.538	1.875~10.982	0.001	9.028		2.680~30.413	<0.001
尿酸	0.998	0.996~1.000	0.116	0.999		0.966~1.001	0.286
碱性磷酸酶	1.011	1.005~1.018	0.001	—		—	—