胸中下段食管鳞癌左开胸根治术前中性粒细胞与淋巴细胞比值对预后的评估价值

目的:探讨术前外周静脉血中性粒细胞与淋巴细胞比值(NLR)在胸中下段食管鳞状细胞癌左胸入路根治术预后中的评估价值.方法:回顾性分析2007年1月至2011年12月首次治疗在我院经左胸入路行根治性切除的109例胸中下段食管鳞状细胞癌患者的临床病理资料,NLR临界值为2.5.结果:全组患者中位随访时间为38.0个月,术前NLR 0.89~6.16,中位值2.42,低NLR组(NLR<2.5)56例,高NLR组(NLR≥2.5)53例.术后病理淋巴结转移患者NLR高值的比例高于无淋巴结转移患者(P=0.028);不同病理TNM分期(I-III)间NLR高值的比例存在差异(P=0.006).高NLR组总体生存时间中位值为23.0个月,短于低NLR组61.0个月(P<0.001).单因素分析显示,病理T、N、TNM分期和NLR是患者预后不良的影响因素(P<0.001).Cox比例风险回归模型多因素分析显示,病理TNM分期(HR=2.377,P=0.015)和NLR(HR=2.887,P<0.001)是患者预后的独立影响因素.结论:术前外周静脉血NLR高是接受左胸入路根治性切除的胸中下段食管鳞状细胞癌患者总体生存预后不良的独立影响因素.

Prognostic role of preoperative neutrophil - to - lymphocyte ratio of squamous cell carcinomain middle and lower thoracic esophagus after radical resection through left - sidedthoracic incision

Objective:To determine the prognostic role of preoperative peripheral venous blood neutrophil - to -lymphocyte ratio(NLR)of esophageal squamous cell carcinoma(ESCC)in middle and lower thoracic esophagus afterradical resection through left - sided thoracic incision. Methods:Data from 109 patients diagnosed with ESCC bypathological examination in middle and lower thoracic esophagus who had undergone curative resection through left -sided thoracic incision without neoadjuvant therapy at our hospital between January 2007 and December 2011 wereretrospectively recruited for analysis. The cutoff value of NLR was 2. 5. Results:Median postoperative follow - up timewas 38. 0 months. The median value of NLR was 2. 42 (preoperative range,0. 89 ~ 6. 16). 56 cases were in low -NLR group (NLR <2. 5)and the others (53 cases)were in high - NLR group (NLR≥2. 5). Higher preoperativeNLR was associated with significantly increased risks of pathological lymph node metastasis (P =0. 028). The associationbetween the NLR and the pathological TNM stage (I - III)was statistically significant (P =0. 006). The medianOS of the high - NLR group was 23. 0 months,shorter than 61. 0 months in the median OS of the low - NLR group(P <0. 001). Univariate analysis showed pathological T,N,TNM stage and NLR were associated with adverse overallsurvival (OS)(P <0. 001). A significant,independent association between pathological TNM stage (HR =2. 377,P=0. 015),high preoperative NLR (HR =2. 887,P <0. 001)and poor clinical outcome was identified in a multivariateCox regression analysis for OS. Conclusion:Preoperative higher peripheral venous blood NLR is a independentprognostic marker of adverse OS for ESCC in middle and lower thoracic esophagus undergone radical resection throughleft - sided thoracic incision.