术前中性粒细胞与淋巴细胞比值预测高级别脑胶质瘤患者预后的价值分析  

A value analysis of preoperative neutrophil-to-lymphocyte ratio in predicting the prognosis of patients with high-grade glioma

作　　者：洪慧 李惠娴 张悦宁 刘倩 刘晓珍[2] 张金岭 HONG Hui;LI Huixian;ZHANG Yuening;LIU Qian;LIU Xiaozhen;ZHANG Jinling(Jinzhou Medical Univercity,Liaoning Jinzhou 121000,China;Department of Oncology,Linyi People's Hospital,Shandong Linyi 276000,China;Binzhou Medical Univercity,Shandong Yantai 264000,China;Weifang Medical University,Shandong Weifang 261000,China.)

机构地区：[1]锦州医科大学,辽宁锦州121000 [2]临沂市人民医院肿瘤科,山东临沂276000 [3]滨州医学院,山东烟台264000 [4]潍坊医学院,山东潍坊261000

出　　处：《现代肿瘤医学》2024年第3期451-455,共5页Journal of Modern Oncology

基　　金：山东省自然科学基金面上项目(编号:ZR2020MH292)。

摘　　要：目的:探讨术前中性粒细胞与淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)对脑胶质瘤患者临床预后的预测价值。方法:回顾性分析2011年02月至2016年11月在临沂市人民医院经术后病理确诊为胶质瘤的247例患者的病历资料。采用Cox回归模型分析影响患者预后的临床病理因素,并确定影响其预后的独立危险因素。针对独立危险因素,采用基于最小P值法的X-tile软件确定其预后危险分层的最佳截断值。结果:多因素分析显示NLR(P=0.048,HR=1.12,95%CI:1.00~1.26)、年龄(P=0.001,HR=1.04,95%CI:1.01~1.06)、病理诊断(P=0.001,HR=2.23,95%CI:1.51~3.31)、IDH1(P=0.040,HR=0.37,95%CI:0.14~0.95)是影响胶质瘤患者总生存期(overall survival,OS)的独立影响因素。术前NLR<2.21组预后最好,NLR>3.15组预后最差,NLR≥2.21并且≤3.15预后中等。Kaplan-Meier生存分析显示高NLR组生存时间明显短于低NLR组,高、中、低NLR组5年生存率分别为36%、50%和60%(P<0.05)。在不同肿瘤级别的亚组分析中,多因素分析显示术前NLR(P=0.005,HR=1.29)、年龄(P=0.026,HR=1.03)、IDH1(P=0.03,HR=0.26)、Ki-67(P<0.01,HR=5.53)是影响高级别胶质瘤的独立预后因素。在低级别胶质瘤亚组中,术前NLR与预后相关(P=0.028,HR=1.23)。Kaplan-Meier生存曲线显示,在高级别胶质瘤中,低、中、高NLR组患者的5年OS率逐步降低(P=0.0004);而在低级别胶质瘤中,患者的5年OS率无统计学意义(P=0.518)。结论:NLR是脑胶质瘤患者生存的独立预后因素,根据NLR值可以将高级别胶质瘤患者的临床预后分为高、中、低风险组。Objective:To investigate the predictive value of pre-operative neutrophil-lymphocyte ratio(NLR)on the clinical prognosis of glioma patients.Methods:The clinical data of 247 patients with postoperatively pathologically confirmed glioma in Linyi People's Hospital from February 2011 to November 2016 were retrospectively analyzed.Cox regression modelwas used to analyze the clinicopathological factors affecting patients'prognosis,and to clarify the independent risk factors affecting the prognosis.For independent risk factors,X-tile software based on the minimum P-value method was used to determine the optimal cutoff value for their prognostic risk stratification.Results:Multifactorial analysis showed that NLR(P=0.048,HR=1.12),age(P=0.001,HR=1.04),pathological diagnosis(P=0.001,HR=2.23)and IDH1(P=0.040,HR=0.37)were independent influencing factors affecting overall survival of patients with glioma.The group of glioma patients with preoperative NLR less than2.21 had the best prognosis,the group of glioma patients with NLR greater than 3.15 had the worst prognosis,and the group of glioma patients with NLR greater than or equal to 2.21 and less than or equal to 3.15 had an intermediate prognosis.The Kaplan-Meier survival analysis showed that the OS time in the high NLR group was significantly shorter than that in the low NLR group.In the high,medium,and low NLR groups,the 5-year survival rates were 36%,50%,and 60%,respectively(P<0.05).In a subgroup analysis of different tumor grades,the results of Cox multifactorial analysis showed that preoperative NLR(P=0.005,HR=1.29),age(P=0.026,HR=1.03),IDH1(P=0.03,HR=0.26),and Ki-67(P<0.01,HR=5.53)were independent prognostic factors affecting high-grade glioma.In the low-grade glioma subgroup,preoperative NLR(P=0.028,HR=1.23)was significantly associated with prognosis.Kaplan-Meier survival curves showed that in high-grade glioma,the 5-year survival rate of patients in the low-to-high NLR group gradually decreased(P=0.0004),and in low-grade glioma,the 5-year OS rate of NLR was not stat

关 键 词：中性粒细胞与淋巴细胞比例 脑胶质瘤 分层预后 

分 类 号：R739.41[医药卫生—肿瘤]