Background: Malnutrition is commonly associated with poor prognosis in patients with malignant tumors. The neutrophil-to-lymphocyte ratio (NLR) is an indicator of inflammation in the body and predicts the risk of malnutrition in a variety of diseases; however, its association with malnutrition in lung cancer patients is unclear. The aim of this study is to clarify the association between NLR and nutritional status in stage IV primary lung cancer and to further determine the optimal NLR cut-off that best predicts the risk of malnutrition.
Methods: A retrospective analysis of 209 patients admitted to the Department of Medical Oncology, Tianjin Medical University General Hospital with a primary diagnosis of stage IV lung cancer from May 2019 to February 2021 was performed, and the nutritional risk screening 2002 (NRS 2002) was used to examine their nutritional status. Patient demographic information, pathology, Karnofsky performance status (KPS) score, body mass index (BMI), comorbidities and clinical biochemical indicators were also included. The correlation between NLR and NRS 2002 was investigated. Receiver operating characteristic (ROC) curve was used to determine the best NLR cut-off predi cting malnutrition risk. Multivariable Logistic regression was used to assess the association between NLR and malnutrition risk.
Results: The rate of patients with stage IV primary lung cancer at nutritional risk was 36.36% (76/209). A significant positive correlation was observed between NLR values and NRS 2002 risk score (r=0.765, P<0.001). The ROC curve analysis indicated that an NLR of 3.94 was the optimal cut-off for predicting malnutrition risk (area under the curve=0.747, 95%CI: 0.678-0.815, P<0.001), which showed a sensitivity of 55%, a specificity of 86%, a positive predictive value of 68%, and a negative predictive value of 77%. Patients in the NLR>3.94 group had a significantly higher risk of malnutrition compared to those in the NLR≤3.94 group (69.49% vs 23.33%, P<0.001). Furthermore, NLR was identified as a risk factor for malnutrition in stage IV primary lung cancer patients.
Conclusions: NLR is associated with the risk of malnutrition in stage IV primary lung cancer, and NLR can be used as one of the indicators for screening nutritional risk in patients with stage IV primary lung cancer.
【中文题目：初诊IV期肺癌患者中性粒细胞/淋巴细胞比值与营养不良风险的相关性分析】 【中文摘要：背景与目的 恶性肿瘤患者往往伴随营养不良，与预后密切相关。中性粒细胞与淋巴细胞比值（neutrophil-to-lymphocyte ratio, NLR）作为体内炎症的指标，能够预测多种疾病的营养不良风险，然而其与肺癌患者营养不良的关系尚不明确。本研究旨在分析NLR与初诊IV期肺癌患者营养不良风险的关系，并进一步确定NLR的截断值以更好地预测患者营养不良的风险。方法 回顾性分析2019年5月至2021年2月天津医科大学总医院肿瘤内科收治的209例初诊IV期肺癌患者，应用营养风险筛查2002（nutritional risk screening 2002, NRS 2002）量表对其营养状况进行评估，同时收录患者人口学信息、病理、卡氏体能状态（Karnofsky performance status, KPS）评分、体重指数、合并疾病及临床生化指标的资料。分析NLR与营养不良风险的关系，并采用受试者工作特征（receiver operating characteristic, ROC）曲线来确定预测营养不良风险的最佳NLR临界值。应用多因素Logistic回归进一步评估NLR与营养不良风险之间的关系。结果 初诊IV期肺癌患者存在营养不良风险的比率为36.36%（76/209）。对NLR与NRS 2002营养不良风险评分进行分析发现，NLR与营养不良风险评分呈正相关（r=0.765, P<0.001）。通过ROC曲线分析，确定初诊IV期肺癌患者营养不良风险的最佳截断值NLR为3.94［曲线下面积（area under the curve, AUC）=0.747，95%CI: 0.678-0.815，P<0.001］，敏感性为55%，特异性为86%，阳性预测值为68%，阴性预测值为77%。相比于NLR≤3.94组的患者，NLR>3.94组的患者更容易发生营养不良（69.49% vs 23.33%, P<0.001），并且NLR为初诊IV期肺癌患者营养不良风险的独立危险因素。结论 NLR在初诊IV期肺癌患者中与营养不良风险有关，NLR可作为IV期肺癌患者营养风险筛查的指标之一。 】 【中文关键词：营养；肺肿瘤；中性粒细胞与淋巴细胞比值】.
Keywords: Lung neoplasms; Malnutrition; Neutrophil-to-lymphocyte ratio.