NLR、PLR联合Ki67的表达水平对非小细胞肺癌含铂双药疗效及预后的预测价值  

Predictive value of the levels of NLR and PLR combined with Ki67 on the efficacy of platinum-containing dual drugs in non-small cell lung cancer

作　　者：张胜 罗艳丽 谢慧林 钟宇卓 张文玲 雷震[1] ZHANG Sheng;LUO Yan-li;XIE Hui-lin;ZHONG Yu-zhuo;ZHANG Wen-ling;LEI Zhen(Department of Respiratory and Critical Care Medicine,Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,Sichuan,China)

机构地区：[1]川北医学院附属医院呼吸与危重症医学科,四川南充637000

出　　处：《川北医学院学报》2025年第2期245-248,256,共5页Journal of North Sichuan Medical College

摘　　要：目的:探讨中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)联合Ki67的表达水平对手术不可切除Ⅲ期-Ⅳ期非小细胞肺癌(NSCLC)含铂双药疗效评估及预后的预测价值。方法:选取接受含铂双药治疗的147例初诊晚期NSCLC患者为研究对象。以中位数为临界值将NLR、PLR分为高水平组(n=73)及低水平组(n=74);根据病理免疫组织化学Ki67表达结果分为高表达组(n=91)和低表达组(n=56)。随访至2023年8月31日,评估不同NLR、PLR及Ki67分组的临床疗效;采用Kaplan-Meier方法评估与患者总生存期(OS)之间的关系,Log-rank检验进行组间比较;使用单因素和多因素Cox回归分析预后影响因素;使用“timeROC”评估NLR、PLR、Ki67单独及联合预测预后价值。结果:高NLR组和高Ki67表达组的客观缓解率(ORR)与疾病控制率(DCR)均低于低NLR组和低Ki67表达组(P<0.05),不同水平PLR组的疗效分析差异无统计学意义(P>0.05)。高NLR组、PLR组和高表达Ki67组患者中位生存时间均低于低NLR组、PLR组和低表达Ki67组(P<0.05)。单因素分析显示,临床分期、N分期、多处转移、ECOG评分、NLR、PLR、Ki67与患者OS降低相关(P<0.05)。多因素分析显示,ECOG评分、Ki67是晚期NSCLC患者OS不良的重要独立影响因素(P<0.05)。NLR、PLR、Ki67联合对预测预后的AUC(73.36)和C-index指数(0.689)最高。结论:治疗前高NLR及高Ki67的NSCLC患者在接受使用含铂药物化疗反应较差;高NLR、PLR、Ki67患者OS较短,NLR、PLR和Ki67联合预测接受含铂药物化疗治疗的NSCLC患者的预后效能最高,可更有效为临床医生对患者进行危险分层管理和个体化治疗提供参考。Objective:To evaluate the efficiency and predict the outcome of platinum-containing dual drugs treatments,the researchers examined the neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR),and Ki67 levels in the peripheral blood of stageⅢ-Ⅳnon-small cell lung cancer(NSCLC)patients.Methods:A retrospective analysis was conducted on 147 patients diagnosed with advanced NSCLC in this research.The patients underwent treatment with platinum-containing dual drugs therapy.NLR and PLR were divided into high-level group(n=73)and low-level group(n=74)based on the median value,and according to the pathological immunohistochemistry results of Ki67 expression,they were divided into a high expression group(n=91)and a low expression group(n=56).The effectiveness of NLR,PLR,and Ki67 in various subgroups was analyzed,and their correlation with overall patient survival(OS)was examined through Kaplan-Meier analysis.Between-group comparisons were performed using the Log-rank test.Prognostic factors were analyzed through univariate and multivariate COX regression.The prognostic value of NLR,PLR,and Ki67 was further assessed using the“time ROC”for individual and combined analyses.Results:The objective response rate(ORR)and control rate of diseases(DCR)in the high NLR group and the high Ki67 group were lower than those in the lower NLR and low Ki67 group(P<0.05).There was no statistically significant difference in the efficacy analysis of PLR groups at different levels(P>0.05).The median survival time in the high NLR group,high PLR group,and high Ki67 expression group was lower than that in the low NLR group,low PLR group,and low Ki67 expression group(P<0.05).Univariate analysis showed that clinical stage,N stage,multiple metastases,ECOG score,NLR,PLR,Ki67 were associated with decreased OS in patients(P<0.05).Multivariate analysis showed that ECOG score and Ki67 were important independent influencing factors for OS in patients with advanced NSCLC(P<0.05).The combination of NLR,PLR,and Ki67 exhibited the highest A

关 键 词：非小细胞肺癌 中性粒细胞与淋巴细胞比值 血小板与淋巴细胞比值 KI67 预后 

分 类 号：R734.2[医药卫生—肿瘤]