中性粒细胞-淋巴细胞比值对食管鳞状细胞癌术前新辅助放化疗效果的预测价值  

Predictive value of neutrophil-lymphocyte ratio in preoperative neoadjuvant chemoradiotherapy for esophageal squamous cell carcinoma

作　　者：熊凯 肖何[1] 郑继军[1] 谢伟 叶云飞[1] 王阁[1] XIONG Kai;XIAO He;ZHENG Jijun;XIE Wei;YE Yunfei;WANG Ge(Department of Cancer Center,Daping Hospital,Army Medical University(Third Military Medical University),Chongqing,400042,China)

机构地区：[1]陆军军医大学(第三军医大学)大坪医院肿瘤中心,重庆400042

出　　处：《第三军医大学学报》2021年第2期168-174,共7页Journal of Third Military Medical University

摘　　要：目的探究中性粒细胞-淋巴细胞比值(neutrophil-lymphocyte ratio,NLR)在预测食管鳞状细胞癌(esophageal squamous cell carcinoma,ESCC)术前新辅助放化疗效果中的价值。方法选择本中心2016年1月至2020年6月行术前新辅助放化疗ESCC患者104例,收集行新辅助放化疗前3 d的血常规检验结果,主要包括:中性粒细胞计数、淋巴细胞计数、单核细胞计数、血小板计数,并计算NLR、血小板-淋巴细胞比值(platelet lymphocyte ratio,PLR)、淋巴细胞-单核细胞比值(lymphocyte monocyte ratio,LMR)。利用新辅助治疗前后碘水造影、胸部增强CT记录判断肿瘤退缩等级,并对所有患者的生存状况进行随访。采用Mann-Whitney U检验分析组间连续变量差异。受试者工作曲线(receiver operator characteristic curve,ROC)分析NLR对新辅助缓解预测效能和最佳截断值。χ^2检验分析不同组间临床特征构成比差异。Logistic回归分析新辅助缓解独立预测因素。Cox回归分析总生存(overall survival,OS)独立预后因素。结果新辅助放化疗后达到完全缓解(complete remission,CR)、部分缓解(partial remission,PR)、稳定(stable disease,SD)和进展(progression disease,PD)的患者分别有0例、38例、54例和12例。治疗前血液NLR是ESCC新辅助放化疗缓解的独立预测因素(OR=0.404,95%CI:0.208~0.787,P=0.008)。ROC曲线分析显示NLR对新辅助放化疗后达到缓解有中等预测效能(AUC=0.737,95%CI:0.631~0.844,P<0.001)。根据Youden指数得出最佳截断值为2.77,对应敏感度和特异性分别为0.712和0.737。多因素Cox回归表明只有新辅助治疗后行手术治疗是OS独立预后因素(HR=0.258,95%CI:0.068~0.983,P=0.047)。结论新辅助治疗前ESCC患者血液NLR可能作为治疗后临床缓解情况的独立预测指标,但可能不适用于OS的预测。Objective To explore the value of neutrophil lymphocyte ratio(NLR)in predicting the efficacy of neoadjuvant chemoradiotherapy for esophageal squamous cell carcinoma(ESCC).Methods Clinical data of 104 patients(92 males and 12 females)with esophageal squamous cell carcinoma undergoing preoperative neoadjuvant therapy in our center from January 2016 to June 2020 were collected and analyzed.Blood routine test was carried out in 3 d before neoadjuvant chemoradiotherapy,including neutrophil count,lymphocyte count,monocyte count and platelet count.Then NLR,platelet lymphocyte ratio(PLR)and lymphocyte monocyte ratio(LMR)were calculated respectively.Iodine water radiography and chest enhanced CT scanning were carried out before and after neoadjuvant treatment,so as to determine the regression grade of tumor.The survival status of all patients was followed up for 4~53 months.Mann Whitney U test was used to analyze the difference of continuous variables between groups.Receiver operating characteristic(ROC)curve was applied to evaluate the predictive effect and the best cut-off value of NLR.Chi-square test was performed to analyze the correlation between NLR and clinical characteristics.Logistic regression and Cox regression analyses were adopted respectively to investigate the independent predictors of neoadjuvant remission as well as the independent prognostic factors of overall survival(OS).Results Among the 104 enrolled patients,there were 0,38,54 and 12 cases who achieved complete remission(CR),partial remission(PR),stable disease(SD)and progression disease(PD)criteria respectively after neoadjuvant therapy.NLR before treatment was revealed to be an independent predictor of neoadjuvant chemoradiotherapy remission(OR=0.404,95%CI:0.208~0.787,P=0.008).ROC curve showed that NLR had a moderate predictive effect on neoadjuvant chemoradiotherapy remission(AUC=0.737,95%CI:0.631~0.844,P<0.001),and the optimal cut-off value was 2.77,with the corresponding sensitivity and specificity of 0.712 and 0.737,respectively.However,multiva

关 键 词：中性粒细胞-淋巴细胞比值 食管鳞状细胞癌 新辅助放化疗 缓解情况 

分 类 号：R181.32[医药卫生—流行病学] R446.113[医药卫生—公共卫生与预防医学]