放疗前后中性粒细胞与淋巴细胞比值变化对食管癌预后的预测价值  

Predictive value of ratio change of neutrophil to lymphocytes before and after radiotherapy on prognosis of esophageal cancer

作　　者：张献文[1] 崔珍[1] 蔡丰[1] 张慧慧[1] 刘佳[1] 江浩[1] ZHANG Xianwen;CUI Zhen;CAI Feng;ZHANG Huihui;LIU Jia;JIANG Hao(Department of Radiotherapy,The First Affiliated Hospital of Bengbu Medical College,Anhui 233004,China)

机构地区：[1]蚌埠医学院第一附属医院放疗科,安徽蚌埠233004

出　　处：《淮海医药》2021年第5期441-446,共6页Journal of Huaihai Medicine

基　　金：GPR120在降低食管癌放疗敏感性中的效应及其机制研究(KJ2019A0357);安徽省临床医学优先发展重点专科基金(卫科教秘2018291号)。

摘　　要：目的:观察外周血中性粒细胞与淋巴细胞比值(NLR)在食管鳞癌(ESCC)患者放疗/同步放化疗期间的变化及与总生存率(OS)的关系,评估NLR变化对ESCC患者生存的预测价值。方法:回顾性分析某院接受根治性放疗/放化疗的148例符合条件的ESCC患者的临床资料。收集放疗前、放疗中及放疗后患者的外周血指标,并计算NLR,通过绘制ROC曲线确定NLR预测ESCC患者生存的最佳截断值。根据截断值将其分为高NLR组和低NLR组,分析放疗前后NLR的变化与ESCC患者的临床特征及预后关系,评估影响患者预后的因素。结果:全组患者3年OS为37.8%,放疗前低NLR组与高NLR组患者3年OS分别为63.3%、30.5%;放疗后低NLR组与高NLR组患者3年OS分别为47.9%、28.6%。放疗前及放疗后高NLR组的患者预后均较差。单因素分析显示:T分期、N分期、放疗前NLR、放疗后NLR、放疗前及放疗后NLR差值变化趋势为OS的影响因素。多因素分析表明T分期、N分期、放疗前及放疗后NLR是影响ESCC患者OS的独立因素(P值均<0.05)。结论:放疗前NLR、放疗后NLR及放疗前后NLR变化趋势升高对接受放疗/放化疗的ESCC患者可能是影响生存的预后不良因素,但仍需进一步研究。Objective:To observe the changes of peripheral blood neutrophil to lymphocyte ratio(NLR)during radiotherapy/synchronous radiotherapy and chemotherapy in patients with esophageal squamous carcinoma(ESCC),and the relationship of the changes with overall survival(OS),and to evaluate the predictive value of changes in NLR for survival of patients with ESCC.Methods:Clinical data of 148 eligible patients with ESCC who received radical radiotherapy/radiotherapy and chemotherapy in our hospital were retrospectively analyzed.Peripheral blood indexes of the patients before,during and after radiotherapy were collected,and NLR was calculated.The optimal cut-off value of NLR was determined by drawing ROC curve.The patients were divided into high and low NLR groups according to the cut-off value.Changes of NLR before and after radiotherapy,correlation between clinical characteristics and prognosis of the ESCC patients,and factors affecting the patients'prognosis were analyzed and evaluated.Results:Of all the patients,37.8%had a 3-year OS.The 3-year OS of patients in the low NLR group was 63.3%and 30.5%in the high NLR group before radiotherapy.The 3-year OS of patients in the low NLR group was 47.9%and 28.6%in the high group after radiotherapy.Patients in the high NLR group before and after the radiotherapy had a poor prognosis.Univariate analysis showed that T stage,N stage,pre-radiotherapy NLR,post-radiotherapy NLR,and changed differences between NLR before and NLR after radiotherapy affected OS.Multivariate analysis indicated that T stage,N stage,pre-radiotherapy NLR and post-radiotherapy NLR are independent prognostic factors affecting OS in patients with ESCC(both P<0.05).Conclusion:Pre-radiotherapy NLR,post-radiotherapy NLR and the elevated trend of NLR changes before and after radiotherapy may be a poor prognostic factor affecting the survival of ESCC patients receiving radiotherapy/chemotherapy,but further research is still needed.

关 键 词：食管肿瘤 中性粒细胞与淋巴细胞比值 总生存率 

分 类 号：R735.1[医药卫生—肿瘤]