Pretreatment direct bilirubin and total cholesterol are significant predictors of overall survival in advanced non-small-cell lung cancer patients with EGFR mutations
Pretreatment direct bilirubin and total cholesterol are significant predictors of overall survival in advanced non-small-cell lung cancer patients with EGFR mutations
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DOI：
10.1002/ijc.30581
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发表时间：
2017-04-01
影响因子：
6.4
通讯作者：
Han, Baohui
中科院分区：
文献类型：
--
作者：
Zhang, Yanwei;Xu, Jianlin;Han, Baohui
这项研究旨在检验459例表皮生长因子受体(EGFR)突变的晚期非小细胞肺癌(NSCLC)患者治疗前循环胆红素和胆固醇对总生存率的预测。基线时检测循环总胆红素、直接胆红素(DB)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDLC)和低密度脂蛋白胆固醇(LDLC)水平。所有研究患者的平均年龄(标准差)为58.7(10.5)岁，其中42.9%为男性。曾吸烟者占27.0%，肺腺癌占90.4%。中位随访时间29.5个月，中位生存期34.9个月。与DB较低的患者相比，DB较高的患者死亡风险增加1.68倍(危险比[HR]51.68，95%可信区间[CI]：1.222.30，p50.001)，而TC较低的患者死亡风险降低63%(HR=0.37，95%CI：0.20~0.67，p50.001)。高密度脂蛋白胆固醇水平较低者死亡风险降低46%(HR=0.54，95%CI：0.29~1.00，P=0.049)。在Bonferroni校正后，只有DB和TC与NSCLC的存活率显著相关。我们的研究结果首次证明，在EGFR突变的非小细胞肺癌患者中，预处理DB被确定为显著的危险因素，而TC则被确定为保护因素。
This study was designed to examine the prediction of pretreatment circulating bilirubin and cholesterol for overall survival in 459 advanced non-small-cell lung cancer (NSCLC) patients with epidermal growth factor receptor (EGFR) mutations. Circulating total bilirubin, direct bilirubin (DB), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) levels were measured at baseline. The mean age (standard deviation) of all study patients was 58.7 (10.5) years, and 42.9% of them was males. Ever smokers accounted for 27.0% and lung adenocarcinoma for 90.4%. The median follow-up time and survival time were 29.5 and 34.9 months, respectively. Patients with higher DB had a 1.68-fold increased risk of death compared with patients with lower DB (hazard ratio [HR] 51.68, 95% confidence interval [CI]: 1.222.30, p50.001), while patients with higher TC were at a 63% reduced risk of death compared with patients with lower TC (HR = 0.37, 95% CI: 0.20-0.67, p50.001). As for HDL-C, patients with higher levels had the risk of death reduced by 46% (HR = 0.54, 95% CI: 0.29-1.00, p = 0.049) compared with patients with lower levels. After the Bonferroni correction, only DB and TC were significantly associated with NSCLC survival. Our findings demonstrate for the first time that pretreatment DB was identified as a significant risk factor, yet TC as a protective factor, for overall survival in NSCLC patients with EGFR mutations.