外周血NLR和HWR水平对非手术食管鳞癌患者预后的影响  

Prognostic values of neutrophil-to-lymphocyte ratio and hemoglobin-to-white blood cell ratio on non-operative esophageal squamous cell carcinoma patients

作　　者：张倩倩 陈伟霖 林征 彭仙娥 胡志坚 张城倩 宋先慧 陈华东 ZHANG Qian-qian;CHEN Wei-lin;LIN Zheng;PENG Xian-e;HU Zhi-jian;ZHANG Cheng-qian;SONG Xian-hui;CHEN Hua-dong(Department of Epidemiology and Health Statis- tics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou 350122, China;Department of Radiation Oncology, Zhangzhou Affiliated Hospital of Fujian Medical Uni- versity, Zhangzhou 363000, China)

机构地区：[1]福建医科大学公共卫生学院流行病与卫生统计学系福建省环境因素与肿瘤省级重点实验室,福建福州350122 [2]福建医科大学附属漳州市医院肿瘤放疗科,福建漳州363000

出　　处：《中华疾病控制杂志》2017年第9期930-934,共5页Chinese Journal of Disease Control & Prevention

基　　金：国家级"大学生创新创业训练计划"项目(201410392021);福建省自然科学基金项目(2015J01305);2014年福建医科大学教授发展基金(JS14005)

摘　　要：目的评价治疗前中性粒细胞与淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)和血红蛋白与白细胞比值(hemoglobin-to-white blood cell ratio,HWR)对非手术治疗食管鳞癌(esophageal squamous cell carcinoma,ESCC)患者预后的影响。方法对2009年10月~2014年11月在漳州市医院收治的362名非手术治疗食管鳞癌患者进行前瞻性分析。x^2检验分析NLR和HWR与患者一般临床特征之间的相关性;Cox比例风险回归模型进行单因素和多因素分析。结果 NLR和HWR最佳分界点分别为1.23和24.92;x^2检验分析结果表明,NLR与患者的性别、肿瘤长度、T分期、临床分期和空腹血糖水平相关;Cox单因素和多因素分析显示,高NLR和高HWR都与患者的不良预后有关;按不同治疗方式进行分层分析,提示NLR只在同期放化疗组中显示与患者预后相关(HR=4.080,95%CI:1.074~15.497,P=0.039),而HWR只在序贯放化疗组显示与患者预后相关(HR=2.625,95%CI:1.311~5.254,P=0.006)。结论治疗前高NLR和高HWR均与非手术治疗食管鳞癌患者的不良预后有关。Objective To evaluate the predictive value of neutrophil-to-lymphocyte ratio （NLR） and hemoglobinto-white blood cell ratio （HWR） prior to treatment in prognosis of non-operative esophageal squamous cell carcinoma （ESCC） patients.Methods From October 2009 to November 2014,a total of 362 non-operative ESCC patients were enrolled in this prospective study.x2 test was used to analyze the relationship between NLR,HWR and general clinical features;Univariate and multivariate Cox regression analysis was performed to evaluate the association between variables and prognosis of non-operative ESCC patients.Results The optimal cutoff level of 1.23 for NLR and 24.92 for HWR were identified by X-title software.x2 test indicated NLR was significantly associated with gender,tumor length,T stage,TNM stage and fasting blood glucose level.Moreover,univariate and multivariate analyses showed that high NLR and high HWR were all associated with a poor prognosis in non-operative ESCC.However,when patients were specifically stratified by treatment modus,subset analysis showed that NLR was only predictive of prognosis in the concurrent chemoradiotherapy group （HR =4.080,95% CI：1.074-15.497,P =0.039）,whereas the influence of HWR on prognosis was just existed in the sequential chemoradiotherapy group （HR =2.625,95% CI：1.311-5.254,P =0.006）.Conclusions In this investigation,we found that high NLR and high HWR were associated with poor prognosis in non-operative ESCC.

关 键 词：食管肿瘤 预后 流行病学方法 

分 类 号：R735.1[医药卫生—肿瘤] R181.23[医药卫生—临床医学]