治疗前外周血血红蛋白×淋巴细胞/单核细胞水平对鼻咽癌患者预后的影响  

Prognostic value of pretreatment peripheral blood hemoglobin×lymphocyte/monocyte ratio in patients with nasopharyngeal carcinoma

作　　者：邓超[1] 陈醉 凌捷 谢阳春 赵夏琰 胡春宏[1] 刘先领[1] 冯瑜桦 侯涛[1] DENG Chao;CHEN Zui;LING Jie;XIE Yangchun;ZHAO Xiayan;HU Chunhong;LIU Xianling;FENG Yuhua;HOU Tao(Deparment of Oncology,Second Xiangya Hospital,Changsha 410011,China)

机构地区：[1]中南大学湘雅二医院肿瘤中心,长沙410011

出　　处：《中南大学学报(医学版)》2024年第12期1909-1918,共10页Journal of Central South University :Medical Science

基　　金：湖南省临床医疗技术创新引导项目(2021SK53515)。

摘　　要：目的:外周全血细胞计数可作为多种肿瘤的预后预测因子,但其在鼻咽癌预后中的预测价值仍未可知。本研究探讨治疗前外周血血红蛋白×淋巴细胞/单核细胞(hemoglobin×lymphocyte/monocyte ratio,HLMR)水平对接受根治性放疗的非复发转移性鼻咽癌患者预后的影响。方法:回顾性分析805例完成根治性放疗或放化疗的鼻咽癌患者的临床病理资料及随访记录,收集患者治疗前的外周血血红蛋白、淋巴细胞计数和单核细胞计数结果,计算HLMR值,绘制受试者操作特征(receiver operating characteristic,ROC)曲线,并判定患者HLMR的最佳临界值;根据最佳临界值,将患者分为高HLMR组和低HLMR组,使用χ2检验分析HLMR与患者临床病理特征的关系;使用Cox风险模型确定影响鼻咽癌患者总生存期和无进展生存期的独立危险因素。根据独立危险因素建立诺莫图,预测患者的生存率,并利用验证队列进行内部验证。结果:ROC曲线显示HLMR对鼻咽癌患者5年生存率的最佳临界值为605.5,多因素Cox回归分析显示:T分期(HR=1.886,95%CI 1.331~2.673,P<0.001),N分期(HR=2.021,95%CI1.267~3.225,P=0.003),美国东部肿瘤协作组(Eastern Cooperative Oncology Group,ECOG)评分(HR=3.991,95%CI1.257~12.677,P=0.019),同步放化疗模式(HR=0.338,95%CI 0.156~0.731,P=0.006),HLMR(HR=0.648,95%CI0.460~0.912,P=0.013)为患者总生存期的独立预后因素。在训练队列中,纳入T分期、N分期、HLMR等因素建立诺莫图预测患者3、5和7年的总生存率,该模型的C-index为0.713,其对患者3、5和7年生存率预测的曲线下面积分别为0.744、0.665和0.682,校正曲线分析表明该模型预测的患者生存率与实际观察到的患者生存率具有较好的一致性。上述结果在验证队列中得到进一步证明。结论:治疗前HLMR可能是一个有潜力的鼻咽癌患者预后预测标志物。Objective:Peripheral whole blood cell counts have been used as prognostic indicators for various cancers,but their predictive value in nasopharyngeal carcinoma remain unclear.This study aims to evaluate the prognostic significance of the pretreatment hemoglobin×lymphocyte/monocyte ratio(HLMR)in non-recurrent,non-metastatic NPC patients undergoing definitive radiotherapy.Methods:Clinical and follow-up data from 805 NPC patients who completed definitive radiotherapy or chemoradiotherapy were retrospectively analyzed.Pretreatment hemoglobin,lymphocyte count,and monocyte count were collected to calculate HLMR.Receiver operating characteristic(ROC)curves were used to determine the optimal cut-off value of HLMR.Patients were then classified into high and low HLMR groups.The association between HLMR and clinicopathological characteristic was assessed using chi-square tests.Independent prognostic factors for overall survival(OS)and progression-free survival(PFS)were identified using Cox proportional hazards models.A nomogram was constructed based on the independent predictors to estimate patient survival rates,and internal validation was performed using a validation cohort.Results:The ROC curve identified 605.5 as the optimal HLMR cut-off value for predicting 5-year survival.Multivariate Cox regression analysis revealed that T stage(HR=1.886,95%CI 1.331 to 2.673,P<0.001),N stage(HR=2.021,95%CI 1.267 to 3.225,P=0.003),Eastern Cooperative Oncology Group(ECOG)score(HR=3.991,95%CI 1.257 to 12.677,P=0.019),concurrent chemoradiotherapy regimen(HR=0.338,95%CI 0.156 to 0.731,P=0.006),and HLMR(HR=0.648,95%CI 0.460 to 0.912,P=0.013)were independent prognostic factors for OS.A nomogram including T stage,N stage,and HLMR in the training cohort was constructed to predict 3-,5-,and 7-year OS,with a C-index of 0.713.The area under the curves for predicting 3-,5-,and 7-year OS were 0.744,0.665,and 0.682,respectively.Calibration curves showed good agreement between predicted and observed survival rates.The above results were further con

关 键 词：血红蛋白×淋巴细胞/单核细胞 鼻咽癌 生存率 临床病理特征 预后标志物 

分 类 号：R73[医药卫生—肿瘤]