Clinical and Pathological Characteristics of Non-small Cell Lung Cancer with Pleural Effusion at Different Hematocrit Levels and Their Correlation with Prognosis

Ruwei JIANG; Lijun XU; Huiru WANG; Siyu HUANG

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Ruwei JIANG, Lijun XU, Huiru WANG, Siyu HUANG. Clinical and Pathological Characteristics of Non-small Cell Lung Cancer with Pleural Effusion at Different Hematocrit Levels and Their Correlation with Prognosis[J]. Journal of Kunming Medical University.

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Clinical and Pathological Characteristics of Non-small Cell Lung Cancer with Pleural Effusion at Different Hematocrit Levels and Their Correlation with Prognosis

1.
Department of Oncology，Yingshang County People’s Hospital，Fuyang Anhui 236200
2.
Department of Oncology，The Second People’s Hospital of Fuyang ，Fuyang Anhui 236000，China

Received Date: 2025-12-03
Available Online: 2026-03-15

Abstract

Abstract

Objective To investigate the clinical influencing factors of hematocrit （HCT） levels in non-small cell lung cancer （NSCLC） patients with pleural effusion （PE）, and to analyze the impact of HCT levels on the prognosis of patients. Methods A total of 125 patients with NSCLC complicated with PE admitted to the People’ s Hospital of Yingshang County, Anhui Province from January 2020 to May 2025 were selected. The patients were divided into high HCT group （>39.84%）, intermediate HCT group （36.52%–39.84%）, and low HCT group （<36.52%） according to the tertiles of HCT levels after 4 cycles of treatment （subsequent analyses were all based on this time point）. Stepwise regression analysis was used to correct the relationship between clinicopathological characteristics and HCT levels. Multivariate logistic regression was used to analyze the independent correlation between HCT levels and poor prognosis, and further subgroup analyses were conducted by stratifying blood routine indicators, carcinoembryonic antigen （CEA）, and Ki67 nuclear-associated antigen （Ki67）. Sensitivity analysis was conducted using the E-value method. Interval likelihood ratio, receiver operating characteristic （ROC） curve and area under the curve （AUC）, and restricted cubic spline （RCS） were used to analyze the prediction of HCT levels on poor prognosis and the dose-response relationship between them. Kaplan-Meier survival curves were used for survival analysis. Results There were statistically significant differences in gender, age, lymph node metastasis, degree of differentiation, tumor stage, smoking history, HCT, lymphocyte （LY） count, neutrophil （NE） count, neutrophil-lymphocyte count ratio （NLR）, eosinophil （EOS） count, CEA, Ki67, hemoglobin （Hb）, ferritin （Fer）, transferrin saturation （TSAT）, albumin （ALB）, C-reactive protein （CRP） levels , objective response rate and disease control rate among the three groups of patients （all P < 0.05）. Gender, smoking history, tumor stage, and lymphatic metastasis were closely related to HCT levels （P < 0.05）. HCT levels at each time point after treatment were significantly higher in the good prognosis group compared to the poor prognosis group （P < 0.05）. After adjusting for confounding factors, there was still an independent correlation between HCT levels and the risk of poor prognosis （OR = 1.472, 95%CI: 1.345～1.620）. HCT levels were associated with the prognosis of patients with NSCLC complicated with PE within different ranges of NE, LY, NLR, EOS, CEA, and Ki67. The E-value in the sensitivity analysis was 3.983. Low HCT levels could significantly increase the risk of poor prognosis, with a positive likelihood ratio of 6.468 （95%CI: 2.703～15.478）（P < 0.001）, high HCT levels could significantly reduce the risk of poor prognosis, with a likelihood ratio of 0.064 （95%CI: 0.009～0.450）（P < 0.05）. HCT levels had high predictive efficacy for poor prognosis in the overall population and different gender groups, with AUC of 0.940 （95%CI: 0.733～0.988）, 0.823 （95%CI: 0.767～0.876）, and 0.844 （95%CI: 0.753～0.903） respectively, and the optimal cut-off values for HCT levels were 36.24%, 32.89%, and 35.35% respectively. There was a non-linear dose-response relationship between HCT levels and the risk of poor prognosis in the overall population and different gender groups （P_{for non-linear} < 0.05） . The progression-free survival （PFS） of patients with medium and high HCT levels was significantly higher than that of patients with low HCT levels （P < 0.05） . Conclusion Low HCT levels significantly increase the risk of poor prognosis in NSCLC patients with PE. When HCT≤36.24%, the association strength between HCT levels and poor prognosis risk is markedly increased, and this association exists at different levels of NE, LY, NLR, EOS, CEA, and Ki67. Comprehensive monitoring of these indices in clinical diagnosis and treatment has important clinical value for assessing prognosis in these patients.
- Non-small cell lung cancer,
- Pleural effusion,
- Hematocrit,
- Prognosis

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