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Authors
Advisor(s)
Abstract(s)
Introdução: De acordo com a Organização Mundial de Saúde (OMS), o cancro do pulmão
foi a neoplasia com maior incidência entre os homens e a 2ª neoplasia com maior
incidência nas mulheres, no ano de 2022. Nesse ano, foi a neoplasia com mortalidade
mais elevada a nível mundial. Pelo seu enorme peso, em termos de carga de doença e
mortalidade, é fundamental contribuir para a prevenção, deteção precoce e terapêutica
dirigida e eficaz. É vantajoso conhecer potenciais indicadores de prognóstico que
permitam orientar a terapêutica. A inflamação tem um importante papel no
desenvolvimento tumoral, sendo assim de grande interesse determinar o seu potencial
enquanto indicador de prognóstico.
Objetivo: Avaliar a possível relação entre parâmetros inflamatórios, estado nutricional,
reserva funcional e o prognóstico, atendendo à sobrevivência livre de progressão e ao
tempo de sobrevivência, em doentes com Cancro do Pulmão de Não Pequenas Células
(CPNPC) em estadio avançado submetidos a tratamento sistémico.
Métodos: Estudo observacional, transversal, retrospetivo e unicêntrico, por acesso a
informação clínica, de doentes com CPNPC, em estadio avançado, tratados entre 2020 e
2022 na Unidade Local de Saúde da Guarda. Procedeu-se à análise descritiva das
variáveis como o rácio neutrófilo-linfócito (N/L), o rácio plaqueta-linfócito (P/L), o valor
de lactato desidrogenase (LDH), o índice de massa corporal (IMC), o Performance Status
(PS), o valor de albumina e das proteínas totais e, em seguida, a testes para comparação
de médias, recorrendo ao teste de Mann-Whitney, Kruskal-Wallis ou teste t. Fez-se ainda
avaliação da sobrevivência através da análise de Kaplan-Meier com o teste Log rank. Os
testes foram aplicados para a totalidade da amostra e, posteriormente, em subgrupos de
acordo com o tratamento realizado e o estadio inicial.
Resultados: A amostra consistiu num grupo de 67 doentes com CPNPC, em estadio
avançado. A média da sobrevivência livre de progressão foi de 16,31 (± 12,67) meses e da
sobrevivência global foi de 21,13 (± 19,97) meses. Verificou-se que um rácio P/L elevado
esteve associado a piores outcomes, na totalidade dos doentes, no subgrupo que fez
quimioterapia e no subgrupo que fez imunoterapia. Nomeadamente, para o rácio P/L
inicial verificou-se que o grupo com P/L <169 teve uma sobrevivência livre de progressão
igual a 1,45 vezes a sobrevivência livre de progressão do grupo com P/L>169. Além disso,
a sobrevivência global do grupo com P/L <169 foi igual a 1,87 vezes a sobrevivência global
do grupo com P/L>169. Também o grupo com rácio N/L elevado teve piores outcomes nos doentes tratados com imunoterapia, embora essa tendência seja sugerida por um
menor número de resultados.
Conclusão: Verificou-se que os biomarcadores inflamatórios e nutricionais,
especialmente o rácio P/L, mas também o rácio N/L, quando elevados, condicionam um
pior prognóstico em doentes com CPNPC em estadio avançado, diminuindo a
sobrevivência livre de progressão e a sobrevivência global. Estes achados são
congruentes com estudos anteriores, no entanto, reitera-se a necessidade de mais
estudos que permitam validar estes biomarcadores e estabelecer valores de cut-offs
específicos.
Introduction: According to the World Health Organization (WHO), lung cancer was the most common neoplasia among men and the 2nd most common neoplasia among women, in 2022. That year, it was the most lethal neoplasia globally. Due to its enormous weight in terms of disease burden and mortality, it is essential to contribute to its prevention, early detection, and targeted and effective therapy. It is advantageous to identify potential prognostic indicators that can guide therapy. Inflammation plays an important role in tumor development, and it is, therefore, of high interest to determine its potential as prognostic indicator. Objective: Evaluate the potential relationship between inflamatory parameters, nutritional status, performance status and prognostic, considering progression-free survival and overall survival, in patients with advanced stage Non-Small Cell Lung Cancer (NSCLC) undergoing systemic treatment. Methods: Observational, cross-sectional, retrospective, single-center study, through access to clinical information, of patients with advanced stage NSCLC, treated between 2020 and 2022 at Unidade Local de Saúde da Guarda. Descriptive analysis of the variables - such as neutrophil-to-lymphocyte ratio (N/L), platelet-to-lymphocyte ratio (P/L), lactate dehydrogenase (LDH) levels, body mass index (BMI), Performance Status (PS), albumin levels, and total protein levels - was conducted, followed by tests for comparison of means using the Mann-Whitney test, Kruskal-Wallis test, or t-test. Survival assessment was also performed using Kaplan-Meier analysis with the Log-rank test. The tests were applied to the entire sample and subsequently to subgroups based on the treatment received and the initial stage of the disease. Results: The study sample consisted of 67 patients with advanced stage NSCLC. The average progression-free survival time was 16.31 (± 12.67) months, and the average overall survival was 21.13 (± 19.97) months. A high P/L ratio was associated with worse outcomes in the overall patient sample, as well as in the subgroup undergoing chemotherapy and the subgroup undergoing immunotherapy. Specifically, for the initial P/L ratio, it was found that the group with P/L <169 had a progression-free survival time equal to 1.45 times the progression-free survival time of the group with P/L >169. Additionally, the overall survival of the group with P/L <169 was equal to 1.87 times the overall survival of the group with P/L >169. Similarly, the group with a high N/L ratio experienced worse outcomes in patients treated with immunotherapy, although this association was suggested by a smaller number of results. Conclusion: It was found that inflammatory and nutritional biomarkers, especially the P/L ratio, but also the N/L ratio, when elevated, correlate with a worse prognosis in patients with advanced-stage NSCLC, leading to decreased progression-free survival and overall survival. These findings are consistent with previous studies; however, the need for further research to validate these biomarkers and establish specific cut-off values is reiterated.
Introduction: According to the World Health Organization (WHO), lung cancer was the most common neoplasia among men and the 2nd most common neoplasia among women, in 2022. That year, it was the most lethal neoplasia globally. Due to its enormous weight in terms of disease burden and mortality, it is essential to contribute to its prevention, early detection, and targeted and effective therapy. It is advantageous to identify potential prognostic indicators that can guide therapy. Inflammation plays an important role in tumor development, and it is, therefore, of high interest to determine its potential as prognostic indicator. Objective: Evaluate the potential relationship between inflamatory parameters, nutritional status, performance status and prognostic, considering progression-free survival and overall survival, in patients with advanced stage Non-Small Cell Lung Cancer (NSCLC) undergoing systemic treatment. Methods: Observational, cross-sectional, retrospective, single-center study, through access to clinical information, of patients with advanced stage NSCLC, treated between 2020 and 2022 at Unidade Local de Saúde da Guarda. Descriptive analysis of the variables - such as neutrophil-to-lymphocyte ratio (N/L), platelet-to-lymphocyte ratio (P/L), lactate dehydrogenase (LDH) levels, body mass index (BMI), Performance Status (PS), albumin levels, and total protein levels - was conducted, followed by tests for comparison of means using the Mann-Whitney test, Kruskal-Wallis test, or t-test. Survival assessment was also performed using Kaplan-Meier analysis with the Log-rank test. The tests were applied to the entire sample and subsequently to subgroups based on the treatment received and the initial stage of the disease. Results: The study sample consisted of 67 patients with advanced stage NSCLC. The average progression-free survival time was 16.31 (± 12.67) months, and the average overall survival was 21.13 (± 19.97) months. A high P/L ratio was associated with worse outcomes in the overall patient sample, as well as in the subgroup undergoing chemotherapy and the subgroup undergoing immunotherapy. Specifically, for the initial P/L ratio, it was found that the group with P/L <169 had a progression-free survival time equal to 1.45 times the progression-free survival time of the group with P/L >169. Additionally, the overall survival of the group with P/L <169 was equal to 1.87 times the overall survival of the group with P/L >169. Similarly, the group with a high N/L ratio experienced worse outcomes in patients treated with immunotherapy, although this association was suggested by a smaller number of results. Conclusion: It was found that inflammatory and nutritional biomarkers, especially the P/L ratio, but also the N/L ratio, when elevated, correlate with a worse prognosis in patients with advanced-stage NSCLC, leading to decreased progression-free survival and overall survival. These findings are consistent with previous studies; however, the need for further research to validate these biomarkers and establish specific cut-off values is reiterated.
Description
Keywords
Cancro do Pulmão de Não Pequenas Células Marcadores de Prognóstico Sobrevivência Livre de Progressão Tempo de Sobrevida