中性粒细胞淋巴细胞计数比值和血小板淋巴细胞计数比值与甲状腺微小乳头状癌中央区淋巴结转移的关系  

Correlation analysis of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio and central cervical lymph node metastasis of papillary thyroid microcarcinoma

作　　者：宋创业 孟艳林 刘冰 严丽[3] 尚培中 贾志芳 姜永斌 孟繁玉 Song Chuangye;Meng Yanlin;Liu Bing;Yan Li;Shang Peizhong;Jia Zhifang;Jiang Yongbin;Meng Fanyu(Department of General Surgery,the 81st Chinese People's Liberation Army Hospital,Zhangjiakou 075000,China;Department of Infection Control Division,the SJSI Chinese People's Liberation Army Hospital,Zhangjiakou 075000,China;Department of Glandular Surgery,the Second Hospital of Hebei Medical University,Shijiazhuang 050005,China;Department of General Surgery,Zhangjiakou First Hospital,Zhangjiakou 075000,China;Department of General Surgery,Zhuolu County Maternal and Child Health Hospital,Zhangjiakou 075600,China)

机构地区：[1]解放军陆军第八十一集团军医院普通外科,张家口075000 [2]解放军陆军第八十一集团军医院疾病预防控制科,张家口075000 [3]河北医科大学第二医院腺体外科,石家庄050005 [4]张家口市第一医院普通外科,075000 [5]张家口市涿鹿县妇幼保健院普通外科,075600

出　　处：《中华肿瘤杂志》2021年第9期944-948,共5页Chinese Journal of Oncology

基　　金：张家口市重点研发计划(1921125H)。

摘　　要：目的探讨中性粒细胞淋巴细胞计数比值(NLR)、血小板淋巴细胞计数比值(PLR)与cN0期甲状腺微小乳头状癌(PTMC)中央区淋巴结转移(CLNM)的关系。方法收集2016—2019年解放军陆军第八十一集团军医院经手术治疗、病理证实为PTMC患者的临床病理资料,分析患者术前外周血NLR、PLR水平与术后PTMC CLNM的关系。多因素分析采用logistic回归分析,采用受试者工作特征(ROC)曲线确定NLR和PLR的临界值,采用交互作用相对超额危险度分析NLR、PLR与CLNM的关系。结果220例cN0期PTMC患者中,CLNM 92例。ROC曲线显示,NLR临界值为2.5、PLR临界值为175时,Youden指数最高,分别为0.318和0.264。NLR和PLR与CLNM均有关(均P<0.05),肿瘤长径、肿瘤多灶性、NLR≥2.5和PLR≥175为CLNM的独立影响因素(均P<0.05)。交互作用分析结果显示,交互作用相对超额危险度为5.531(95%CI为0.160~10.901,P=0.016),归因比为0.512(95%CI为0.230~0.794,P=0.009),协同指数为2.294(95%CI为1.492~4.579,P=0.022),提示NLR、PLR有交互作用,二者协同促进CLNM。结论NLR和PLR为cN0期PTMC CLNM的独立危险因素,当NLR≥2.5、PLR≥175时,应常规行预防性中央区淋巴结清扫术。Objective To investigate the correlation between neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR)and central lymph node metastasis(CLNM)in patients with cN0 papillary thyroid microcarcinoma(PTMC).Methods The clinicopathological data of PTMC patients confirmed by surgery and pathology in the 81st Military Hospital of People′s Liberation Army from 2016 to 2019 were collected,and the relationship between preoperative NLR,PLR levels and postoperative PTMC CLNM were analyzed.Logistic regression analysis was used for multivariate analysis.Receiver operating characteristic(ROC)curve was used to determine the cutoff value of NLR and PLR.The interaction relative excess risk was used to analyze the relationship between NLR,PLR and CLNM.Results Among 220 patients with cN0 stage PTMC,92 were CLNM.The ROC curve showed that when the cutoff value of NLR was 2.5 and the cutoff value of PLR was 175,the highest Youden index was 0.318 and 0.264,respectively.NLR and PLR were both related to CLNM(P<0.05).The tumor long diameter,multifocality,NLR≥2.5 and PLR≥175 were independent impact factors of CLNM(P<0.05).The results of the interaction showed that the relative excess risk of the interaction was 5.531(95%CI:0.160,10.901,P=0.016),the attribution ratio was 0.512(95%CI:0.230,0.794,P=0.009),and the synergy index was 2.294(95%CI:1.492,4.579,P=0.022),suggested that NLR and PLR had an interactive effect,and these two synergistically promoted CLNM.Conclusions NLR and PLR are independent risk factors for cN0 stage PTMC CLNM.When NLR≥2.5 and PLR≥175,preventive central lymph node dissection should be routinely performed.

关 键 词：甲状腺肿瘤 微小乳头状癌 中性粒细胞淋巴细胞计数比值 血小板淋巴细胞计数比值 中央区淋巴结转移 

分 类 号：R736.1[医药卫生—肿瘤]