血脂对中晚期非小细胞肺癌放射治疗患者生存结局的影响研究

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摘要目的探讨血脂对中晚期非小细胞肺癌(NSCLC)放射治疗(简称放疗)患者生存预后的影响。方法对 2018 年 1 月至 2023 年 5 月在四川省肿瘤医院诊治的 164 例Ⅲ至Ⅳ期血脂异常的 NSCLC 放疗患者临床数据进行回顾性分析。通过受试者操作特征曲线(ROC 曲线)确定胆固醇(TC)及甘油三酯(TG)的最佳截断点,并进行分组。采用 Cox 比例风险回归模型及 Kaplan-Meier 生存分析和 log-rank 检验评估预后因素。结果利用 ROC 曲线确定 TC 和 TG 的最佳截断点分别为 5. 72 mmol / L、 1. 795 mmol / L。低 TC 组(<5. 72 mmol / L)疾病控制率(DCR)高于高 TC 组(≥5. 72 mmol / L)(P<0. 05)。低 TC 组的中位无进展生存(PFS)期显著优于高 TC 组(16 个月比 12 个月,P= 0. 0078);但两组的中位总生存(OS)期无统计学差异(44 个月比 36 个月,P= 0. 1681);使用降脂药患者较未使用降脂药患者的 PFS 期(18 个月比 11 个月,P = 0. 014)和 OS 期(54 个月比 35 个月,P= 0. 0270)均显著延长。放疗后胆固醇水平下降患者 PFS 期(16 个月)较升高患者(9 个月)延长 7 个月(P = 0. 0215),OS 期(41 个月比 38 个月)延长 3 个月(P= 0. 2700)。多因素 Cox 比例风险回归模型分析提示肿瘤分期、TC 水平、放疗后 TC 变化趋势及总蛋白是中晚期 NSCLC 预后的独立影响因素(P<0. 05)。结论肿瘤分期、TC 水平及其变化趋势、总蛋白是中晚期 NSCLC 放疗患者的独立影响因素,放疗前 TC 水平,及使用降脂药物能显著延长血脂异常中晚期 NSCLC 放疗患者的 PFS 期及 OS 期,具有改善生存结局的潜力。

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	1熊静
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关键词 ：血脂, 非小细胞肺癌, 放疗, 生存结局, 无进展生存期, 总生存期, 疾病控制率, 降脂药物

Abstract：Objective To investigate the effect of blood lipids on the survival prognosis of intermediate and advanced non-small cell lung cancer NSCLC radiotherapy patients. Method A retrospective analysis was performed on the clinical data of 164 patients with stage Ⅲ to Ⅳ NSCLC and dyslipidemia who received radiotherapy at Sichuan Cancer Hospital from January 2018 to May 2023. The optimal cutoff values for total cholesterol TC and triglyceride TG were determined using the receiver operating characteristic ROC curve with subsequent stratification of patients into corresponding groups. Prognostic factors were evaluated using both univariate and multivariate Cox regression models complemented by Kaplan-Meier survival analysis for statistical comparisons and clinical outcome assessment. Result The ROC curve was used to obtain the optimal cut-off values of cholesterol and triglycerides and the optimal cut-off values of TC and TG were 5. 72 mmol / L and 1. 795 mmol / L respectively. The DCR of the low cholesterol group < 5. 72 mmol / L was significantly higher than that of the high cholesterol group ≥5. 72 mmol / L P<0. 05 . Median progress free survive PFS in the low- cholesterol group was significantly better than that in the high - value group 16 vs 12 months P = 0. 0078 . However there was no statistically significant difference in median overall survival OS between the two groups 44 months vs 36 months P= 0. 1681 . Compared with the non-use group the mPFS 18 months vs 11 months P= 0. 014 and OS 54 vs 35 months P= 0. 027 were significantly longer in the lipid-lowering drug group. The mPFS 16 months of patients with decreased cholesterol levels after radiotherapy was 7 months longer than that of patients with increased cholesterol 9 months P= 0. 0215 and the OS 41 months vs 38 months was 3 months longer P = 0. 2700 . Cox multifactorial analysis suggested that tumor stage cholesterol level,trend of cholesterol change after radiotherapy and total protein were risk factors for NSCLC prognosis P < 0. 05 . Conclusion Tumor stage cholesterol level and its trend and total protein level are independent prognostic factors affecting patients with NSCLC. Pre-radiotherapy cholesterol level and the use of lipid - lowering drugs can significantly improve PFS and OS in patients with dyslipidemia undergoing radiotherapy for intermediate and advanced NSCLC and have the potential to improve survival outcomes.

Key words： Lipids Non - small cell lung cancer Radiotherapy Survival outcomes Progress free survive Overall survival Disease control rate Lipid-lowering drugs

基金资助:四川省自然科学基金(2023NSFSC0712)

通讯作者: 张石川,电子邮箱:zhangsc65@ hotmail. com

引用本文:

1熊静,2吕家华,1,2 张石川. 血脂对中晚期非小细胞肺癌放射治疗患者生存结局的影响研究[J]. 肿瘤代谢与营养电子杂志, 2025, 12(3): 387-397.
1Xiong Jing,2Lyu Jiahua,1,2Zhang Shichuan. A study of the effect of blood lipids on survival in patients undergoing radiotherapy for intermediate to advanced NSCLC. Electron J Metab Nutr Cancer, 2025, 12(3): 387-397.