局部晚期鼻咽癌患者外周血淋巴细胞和单核细胞比例与预后的相关性

目的:回顾性分析局部晚期鼻咽癌患者外周血中淋巴细胞与单核细胞比例（lymphocyte-to-monocyte ratio,LMR)与预后的相关性。方法:收集既往接受同期放化疗的219例Ⅲ/Ⅳa，b期（AJCC第7版分期）鼻咽癌患者，采用外周血中LMR中位值4.31作为阈值来对所有患者进行分层。Log-rank检验对生存结果进行分析。主要生存终点为无进展生存率（PFS）。结果:低LMR值组（<4.31）与更差的T分期(P=0.038)、N分期(P=0.004)、临床分期(P=0.005)、EBV DNA(P=0.000)和死亡(P=0.050)相关。低LMR值组（<4.31）与高LMR值组（≥4.31）患者4年PFS分别为68.2%vs 77.8%（P=0.048）。Cox风险模型多因素分析显示影响PFS的预后因素为N分期（HR=3.27，95%CI=1.72~5.27；P=0.032）、临床分期（HR=1.72，95%CI=1.08~2.43；P=0.001）和EBV DNA（HR=3.55，95%CI=2.50~7.53；P<0.001），而LMR（HR=0.43，95%CI=0.37~1.05；P=0.057）不是独立的预后因素。结论:LMR值下降提示鼻咽癌患者更晚的分期和更差的预后，但对生存的总体预测作用低于传统的AJCC分期和EBV DNA。

The correlation between peripheral blood lymphocyte-to-monocyte ratio and prognostic indicators in patients with locally advanced nasopharyngeal carcinoma

Objective:To evaluate the predictive value of peripheral blood lymphocyte-to-monocyte ratio(LMR) in patients with nasopharyngeal carcinoma（NPC).Methods:Collect 219 patients with Ⅲ/Ⅳa，b(AJCC 7th edition) nasopharyngeal carcinoma（NPC)，who treated by concurrent chemo-RT.We employed a threshold of pretreatment LMR=4.31（median) to stratify patients.Survival outcomes were compared using Log-rank test.The primary end-point was progress-free survival（PFS).Results:Low LMR（<4.31)was associated with advanced T stage（P=0.038)，N stage（P=0.004)，clinical stage（P=0.005)，EBV DNA(P=0.000) and deaths（P=0.050).The 4-year PFS rate was 68.2%for those with LMR ratio<4.31，compared with 77.8%for those with LMR ratio≥4.31（P=0.048）.Multifactorial Cox regression analysis confirmed that in the PFS，the independent prognostic factors were including N stage（HR=3.27，95%CI=1.72~5.27,P=0.032），clinical stage（HR=1.72，95%CI=1.08~2.43,P=0.001） and EBV DNA（HR=3.55，95%CI=2.50~7.53,P<0.001），but the LMR（HR=0.43，95%CI=0.37~1.05,P=0.057） was not included in the independent prognostic factors.Conclusion:The results of LMR had a certain relationship with the prognosis of NPC，and the prognosis of patient with low LMR was poor.However，the predictive ability of LMR was lower than that of AJCC stage and EBV DNA.