Combinaison de la C-réactive protéine et du Neutrophil to Lymphocyte ratio dans la prédiction de survie dans le cancer broncho-pulmonaire non à petites cellules
Mots-clés :
cancer non à petites cellules; inflammation; marqueurs ; pronostic, C réactiveprotéine, neutrophil to lymphocyte ratioRésumé
Prérequis: L’inflammation a été impliquée dans la progression et la dissémination du cancer broncho-pulmonaire et parmi ces marqueurs de l’inflammation la c réactive protéine (CRP) et le neutrophil to lymphocyte ratio (NLR) sont des marqueurs pronostiques dans le cancer broncho-pulmonaire non à petites cellules (CBPNPC). Le but de notre travail est d’étudier l’apport de ces deux marqueurs combinés dans l’optimisation de la prédiction pronostique dans le CBPNPC aux stades avancés.
Méthodes : Nous avons mené une étude rétrospective qui a inclus tous les patients hospitalisés dans notre service entre janvier 2005 et janvier 2013 et ayant un cancer broncho-pulmonaire non à petites cellules (CBPNPC) stade IIIb et IV.
Résultats : Cent quarante-deux patients de sexe masculin sont inclus. La plupart (80,3%) ont un PS évalué à 0-1. La médiane de survie sans progression et de survie globale sont respectivement de 4,6 mois (Intervalle de confiance IC à 95% 3,9-5,3) et 8,9 mois(IC à 95% 7,7-10,1). L’analyse multivariée montre qu’une CRP< 10 mg/l et un NLR<3,87 sont des facteurs de meilleur pronostic (p=0,015 et 0,049) en plus de l’administration de la chimiothérapie (p<0,0001), du PS <2 (p=0,009) et de l’âge<65 ans (p=0,013). De plus, l’utilisation combinée de la CRP et du NLR est significativement associée à la survie (p=0,0009). La médiane de survie des patients ayant la CRP et le NLR élevés est de 6,7 mois, et est significativement inférieure en cas d’élévation d’un seul marqueur (CPR ou NLR) (8,8 mois; p=0,025).
Conclusions: Une CRP et un NLR élevés (respectivement ≥10mg/l et ≥3,87) sont associés à une mauvaise survie dans le CBPNPC aux stades avancés. Leur utilisation combinée optimise leur valeur pronostique.
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