肺癌中贫血驱动的表型：连接炎症与肌肉减少症

摘要(中文译文)

肺癌仍是癌症相关死亡的主要原因之一，其特征是复杂的肿瘤-宿主相互作用，包括全身性炎症、代谢失调和免疫失衡。本研究旨在评估贫血诊断是否反映潜在的炎症负荷，并探讨肺癌患者中贫血、炎症与肌肉消耗之间基于表型的相互作用。研究采用回顾性队列研究设计，纳入2019年至2023年间诊断为肺癌的70例患者。贫血采用标准血红蛋白阈值定义（女性<12 g/dL，男性<13 g/dL）。全身性炎症通过全血细胞计数衍生的指标（NLR、PLR、SII、SIRI和AISI）进行评估，既单独分析也合并为累积炎症评分。肌少症通过基于CT的L3水平骨骼肌面积定量进行评估。根据贫血状态、炎症负荷和肌少症将患者分为四种表型。统计分析采用Mann-Whitney U检验、Kruskal-Wallis检验及Dunn事后检验和单因素logistic回归。44.3%的患者存在贫血，与非贫血患者相比，贫血患者的炎症评分显著更高（中位数5 [IQR 4-5] vs. 4 [3-5]，= 0.024）。在炎症标志物中，PLR与贫血显著相关（OR = 4.94，95% CI：1.57-15.52，= 0.004）。累积炎症评分与贫血的关联无统计学意义（OR = 1.28，95% CI：0.93-1.75，= 0.124）。基于表型的分析显示骨骼肌面积存在显著差异（= 0.004），其中肌少症-炎症表型与其他组相比肌肉量显著更低。未观察到表型与肿瘤分期或组织学亚型之间的关联。肺癌患者的贫血与全身性炎症密切相关，可能反映潜在的生物学脆弱性而非肿瘤特异性特征。整合贫血、炎症标志物和肌少症的基于表型的方法可更全面地理解疾病异质性，并可能改善风险分层。需要进一步研究以验证这些发现并评估其预后意义。

Abstract

: Lung cancer remains a leading cause of cancer-related mortality and is characterized by complex tumor-host interactions, including systemic inflammation, metabolic dysregulation, and immune imbalance. This study aimed to evaluate whether a diagnosis of anemia reflects underlying inflammatory burden and to explore phenotype-based interactions between anemia, inflammation, and muscle depletion in lung cancer patients. : A retrospective cohort study was conducted, including 70 patients diagnosed with lung cancer between 2019 and 2023. Anemia was defined using standard hemoglobin thresholds (<12 g/dL in women, <13 g/dL in men). Systemic inflammation was assessed using complete blood count-derived indices (NLR, PLR, SII, SIRI, and AISI), both individually and combined into a cumulative inflammatory score. Sarcopenia was evaluated through CT-based quantification of skeletal muscle area at the L3 level. Patients were stratified into four phenotypes based on anemia status, inflammatory burden, and sarcopenia. Statistical analyses like Mann-Whitney U, Kruskal-Wallis with Dunn post hoc testing, and univariate logistic regression were used. : Anemia was present in 44.3% of patients and was associated with a significantly higher inflammatory score compared to non-anemic patients (median 5 [IQR 4-5] vs. 4 [3-5], = 0.024). Among inflammatory markers, PLR was significantly associated with anemia (OR = 4.94, 95% CI: 1.57-15.52, = 0.004). The cumulative inflammatory score showed a non-significant association with anemia (OR = 1.28, 95% CI: 0.93-1.75, = 0.124). Phenotype-based analysis revealed significant differences in skeletal muscle area ( = 0.004), with the sarcopenic-inflammatory phenotype exhibiting significantly lower muscle mass compared to other groups. No associations were observed between phenotypes and tumor stage or histological subtype. : Anemia in lung cancer patients is closely associated with systemic inflammation and may reflect underlying biological vulnerability rather than tumor-specific characteristics. A phenotype-based approach integrating anemia, inflammatory markers, and sarcopenia provides a more comprehensive understanding of disease heterogeneity and may improve risk stratification. Further studies are needed to validate these findings and assess their prognostic implications.

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