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

Abstract

Abstract:

ObjectiveTo 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.MethodsA 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.ResultsThe 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 monthsvs. 8.57 months,χ²=35.943,P<0.001; 6.67 monthsvs. 8.20 months,χ²=8.047,P=0.005) and overall survival (OS) (13.37 monthsvs. 23.95 months,χ²=21.355,P<0.001; 14.13 monthsvs. 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.ConclusionBoth 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/Tables7

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(0vs.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
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	—	—	—

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