Peripheral blood inflammation indices are effective predictors of anastomotic leakage in elective esophageal surgery

BackgroundThis study investigated the predictive value of peripheral inflammatory indices, including neutrophil count, lymphocyte count, platelet count, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR), in anastomotic leakage during elective esophageal surgery.MethodsThis retrospective study included all patients who underwent esophagectomy for esophageal squamous cell carcinoma from 2016 to 2020 in our institution. The peripheral blood inflammatory indices were obtained on preoperative days 1–7 (PRD 1–7), and postoperative days 1–3 (POD 1–3) and 4–7 (POD 4-7). Univariate, multivariate logistic, and receiver operating characteristic curve analyses were conducted to evaluate the diagnostic value of these peripheral blood inflammatory indices.ResultsA total of 198 patients were included in the study, and 25 (13%) patients experienced anastomotic leakage. Multivariate analyses identified diet, neutrophil count, and PLR on POD 1–3, and NLR on POD 4–7 as independent factors associated with anastomotic leakage. Using the receiver operating characteristic curve, the variable with the best area under curve was a neutrophil cutoff count of 4.1 [0.737; 95% CI: 0.639–0.835], with a sensitivity and specificity of 60.0% and 66.5%, respectively. This was followed by an NLR cutoff value of 9.5 on POD 4–7 (0.628; 95% CI: 0.505–0.752) and a cutoff PLR value of 220.1 on POD 1–3 (0.643; 95% CI: 0.536–0.750). Diet showed a poor result on the receiver operating characteristic curve analysis.ConclusionsNeutrophil count and PLR on POD 1–3 and NLR on POD 4–7 were shown to have predictive value for anastomotic leakage in elective esophageal surgery.     

外周血炎性标志物在甲状腺癌中的应用进展

甲状腺癌是内分泌系统最常见的恶性肿瘤,近年来其发病率在世界范围内呈上升趋势,虽然总体治愈率高,但局部复发或远处转移也较常见,另有部分患者因肿瘤组织分化低,疾病进展较快而死亡.免疫反应和炎症反应在肿瘤的发生、发展中起着重要的作用,研究表明外周血中某些炎性细胞的数目及其比值是恶性肿瘤的重要预后因子,如血小板、中性粒细胞、淋...     

肝内胆管癌围手术期外周血NLR和PLR对患者预后的预测价值

目的:探讨肝内胆管癌(intrahepatic cholangiocarcinoma,ICCA)围手术期外周血中性粒细胞与淋巴细胞比率(neutrophil-to-lymphocyte ratio,NLR)和血小板与淋巴细胞比率(platelet-to-lymphocyte ratio,PLR)对患者预后的预测价值.方...     

外周血NLR、MLR、SII在甲状腺髓样癌中的应用价值

目的:探讨外周血中性粒细胞与淋巴细胞比值（NLR）、单核细胞与淋巴细胞比值（MLR）、系统免疫炎症指数（SII）在甲状腺髓样癌（MTC）中的应用价值。方法:以我院2012年2月至2020年7月收治的MTC患者50例（MTC组）、甲状腺乳头状癌患者50例（PTC组）、健康体检者50例（健康对照组）为研究对象,比较三组患者外周血NLR、MLR、SII水平的差异,并采用受试者工作特征曲线（ROC）分析上述三个指标及其联合检测在MTC中的诊断效能,进一步根据上述三个指标在诊断MTC中的最佳诊断界值分析其与MTC临床病理特征的相关性。结果:比较各组间外周血NLR、MLR、SII水平示:MTC组NLR显著高于PTC组,差异有统计学意义（P＜0.05）;MTC组MLR、SII水平显著高于PTC组与HC组,差异有统计学意义（P＜0.05）。通过ROC曲线分析发现, NLR、MLR、SII单独诊断MTC患者的ROC曲线下面积分别为0.620、0.681、0.634,NLR、MLR、SII三者联合检测ROC曲线下面积为0.726。MLR单独检测及联合检测对MTC的诊断效能高于NLR、SII单独检测（P＜0.05)。MTC患者MLR与淋巴结转移及TNM分期有关,比较差异有统计学意义（P＜0.05）。结论:NLR、MLR、SII对MTC具有诊断价值,MLR单独检测及联合检测对MTC的诊断效能高于NLR、SII单独检测。MLR与MTC患者淋巴结转移及TNM分期有关。     

Inflammatory Ratios as Predictors for Tumor Invasiveness,Metastasis, Resectability and Early Postoperative Evolution in Gastric Cancer

Our study aimed to evaluate the baseline neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and systemic immune-inflammation index (SII) in relation to invasion, metastasis, and resectability for patients with gastric cancer, respectively, as predictors of death during hospitalization or surgical complications. A retrospective cohort study was conducted on 657 gastric cancer subjects. Inflammatory biomarkers were computed. The associations with tumor stage, metastasis, optimal procedure, in-hospital mortality, and surgical complications were evaluated. Subjects who underwent curative-intent surgery presented lower median NLRs (2.9 vs. 3.79), PLRs (166.15 vs. 196.76), and SIIs (783.61 vs. 1122.25), and higher LMRs (3.34 vs. 2.9) than those who underwent palliative surgery. Significantly higher NLRs (3.3 vs. 2.64), PLRs (179.68 vs. 141.83), and SIIs (920.01 vs. 612.93) were observed for those with T3- and T4-stage cancer, in comparison with those with T1- and T2-stage cancer. Values were significantly higher in the case of metastasis for the NLR (3.96 vs. 2.93), PLR (205.22 vs. 167.17), and SII (1179 vs. 788.37) and significantly lower for the LMR (2.74 vs. 3.35). After the intervention, the NLR, PLR, and SII values were higher (p < 0.01) for patients with surgical complications, and the NLR and SII values were higher for those who died during hospitalization. Higher NLRs, PLRs, SIIs, and lower LMRs were associated with a more aggressive tumor; during early follow-up, these were related to post-operative complications and death during hospitalization.     

全身炎症反应指数(SIRI)在乳腺癌患者中的临床意义和预后价值

目的:探讨乳腺癌患者全身炎症反应指数(systemic inflammatory response index,SIRI)的临床和预后价值.方法:研究对象为1998年01月至2016年12月在我院接受新辅助化疗的乳腺癌患者477例和未接受新辅助化疗的乳腺癌患者308例.ROC曲线(receiver operating ...     

Prognostic value of systemic immune-inflammatory index in survival outcome in gastric cancer: a meta-analysis

BackgroundIn recent years, many studies have reported that the systemic immune-inflammatory index (SII) can be used to predict the prognosis of cancer patients; however, this finding remains controversial in gastric cancer (GC). Therefore, the purpose of this study was to systematically and comprehensively probe the prognostic role of SII in GC.MethodsRelevant publications were extracted from PubMed, EMBASE, Cochrane Library databases, and WANFANG DATA (Chinese database). The included studies had patients with pathologically confirmed GC and long-term follow-up data. The patient''s outcome was death, recurrence, or status at the end of follow-up. The studies included randomized controlled tests, case-control studies, or cohort studies using a multivariate proportional hazard model adjusted for survival outcomes. Cochran’s Q test and Higgins’ I-squared statistic were performed to assess heterogeneity. Publication bias was assessed by visual inspection of a Begg’s funnel plot.ResultsA total of 6,925 patients in 11 studies were included. The pooled hazard ratio (HR) indicated that a higher SII value was significantly associated with worse overall survival (OS) [HR: 1.53, 95% confidence interval (CI): 1.27–1.83] and worse disease-free survival (DFS) (HR: 1.57, 95% CI: 1.24–1.97) in GC patients. In the subgroup analysis, the HR was 1.72 (95% CI: 1.51–1.95) and 1.27 (95% CI: 0.96–1.67) in the group of patients aged <59 and ≥59 years, respectively.ConclusionsThe pooled HR indicates that a higher SII in younger patients with GC predicts a poor prognosis. In elderly patients with GC, the prognostic role of SII needs further research.     

Combining the systemic inflammation response index and prognostic nutritional index to predict the prognosis of locally advanced elderly esophageal squamous cell carcinoma patients undergoing definitive radiotherapy

BackgroundThe systemic inflammation response index (SIRI) and prognostic nutritional index (PNI) have been shown to be correlated with the prognosis of various solid tumors. This study sought to investigate the prognostic value of the SIRI and the PNI individually and in combination in locally advanced elderly esophageal squamous cell carcinoma (ESCC) patients treated with radical radiotherapy.MethodsThe data of 192 ESCC patients aged ≥65 years, who had been treated with definitive radiotherapy between 2013 and 2016, were retrospectively analyzed. The optimal cutoff values of SIRI and PNI were determined by receiver operating characteristic curves. Kaplan-Meier curves and Cox proportional hazards models were used to analyze the effect of the SIRI and PNI on overall survival (OS) and progression-free survival (PFS). The areas under the curve were measured to evaluate the predictive ability of the SIRI, PNI, and SIRI combined with PNI for OS.ResultsThe optimal cutoff values of the pretreatment SIRI and PNI were 1.03 and 49.60, respectively. The univariate and multivariate analyses demonstrated that T stage (P=0.021), TNM stage (P=0.022), synchronous chemotherapy (P=0.032), the SIRI (P=0.001), and the PNI (P=0.045) were independent prognostic factors for OS and N stage (P=0.004), synchronous chemotherapy (P=0.016) and the SIRI (P=0.004) were independent prognostic factors for PFS. The AUC of the combined SIRI and PNI (0.706; 0.612–0.801) was higher than those of the SIRI (0.648; 0.540–0.756) and the PNI (0.621; 0.523–0.720). Patients in the low-SIRI and high-PNI groups, especially those in clinical stage II or who received synchronous chemotherapy (P<0.001, P=0.002), had better OS and PFS than those in the other groups (P<0.001).ConclusionsThe SIRI and PNI are simple and reliable biomarkers for predicting long-term survival in elderly patients with locally advanced ESCC after radical radiotherapy. A high SIRI and a low PNI indicated poor prognosis, and the combination of the SIRI and PNI improved the accuracy of prognosis prediction and could be used to guide individualized treatment of patients.     

影响膀胱癌发生的职业和环境危险因素研究进展

  目的  探讨术前全身炎症反应指数（systemic inflammatory response index,SIRI）对中高危非肌层浸润性膀胱癌（non-muscle invasive bladder cancer,NMIBC）预后的影响。  方法  回顾性分析2013年1月至2015年7月于天津医科大学肿瘤医院行经尿道膀胱肿瘤电切术（transurethral resection of bladder tumor,TURBT）治疗的103例NMIBC患者的临床资料,根据术后患者有无复发或进展分为复发组和未复发组以及进展组和未进展组。根据组间比较结果,绘制SIRI的受试者工作特征曲线（receiver operating characteristic curve,ROC）,求得最优截断值对患者进行分组。通过Kaplan-Meier法和Cox单因素及多因素分析确定影响NMIBC患者预后的危险因素。  结果  SIRI值在复发患者和未复发患者间差异无统计学意义（P=0.393）;患者的年龄（P=0.016）、性别（P=0.030）、肿瘤数目（P=0.008）、分期（P<0.001）、分级（P<0.001）、是否初发（P=0.002）、单核细胞计数（P=0.042）以及SIRI（P=0.044）差异具有统计学意义;根据ROC曲线确定SIRI鉴定患者术后是否出现进展的最佳临界值 ,将患者分为低SIRI组和高SIRI组,生存分析对比两组间的无进展生存期（progression-free survival,PFS）差异具有统计学意义（P=0.005）。Cox多因素分析结果显示,肿瘤数目（P=0.041）、是否初发（ P=0.041）及SIRI≥0.725（P=0.025）是NMIBC 患者TURBT术后PFS的独立预后因素。  结论  SIRI是影响中高危NMIBC患者进展的独立危险因素,术前SIRI对预测肿瘤分期有一定的应用价值。     

cN0期胃癌患者术前中性粒细胞淋巴细胞比?血小板淋巴细胞比和C反应蛋白白蛋白比与术后淋巴结转移的关系

  目的  探讨cN0期（术前影像学诊断）胃癌患者术前外周血中性粒细胞与淋巴细胞比值（neutrophil-to-lymphocyte ratio,NLR）、血小板与淋巴细胞比值（platelet-to-lymphocyte ratio,PLR）和C反应蛋白（C-reactive protein,CRP）与白蛋白比值（C-reac?tive protein-to-albumin ratio,CAR）等系统性炎症反应指标与患者术后淋巴结转移的关系,并建立指数预测模型。  方法  回顾性分析四川省肿瘤医院2019年1月至12月行根治性手术切除的cN0期胃癌患者206例,按照术后病理诊断分为淋巴结转移组（grouppN+）和无淋巴结转移组（group pN0）,同时选取200例同期健康体检者作为健康对照组,比较炎症反应指标之间的差异,以及NLR、PLR、CAR与淋巴结转移数、转移率、淋巴结状态等之间的关系,利用多因素Logistic回归模型筛选cN0期胃癌患者淋巴结转移的独立危险因素。  结果  pN+组胃癌患者术前白细胞计数、中性粒细胞计数、CRP、PLR、NLR、CAR、癌胚抗原（carcinoembryonicantigen,CEA）明显高于pN0组患者,差异均具有统计学意义（均P< 0.05）,而pN0组与健康对照组之间差异均无统计学意义（均P>0.05）;而淋巴细胞计数、血小板计数和白蛋白水平的组间差异无统计意义（均P> 0.05）。术前高NLR组、高PLR组和高CAR组患者的淋巴结分期构成及淋巴结转移数量分别低于术前低NLR组、低PLR组和低CAR组,差异具有统计学意义（均P< 0.05）。单因素及多因素Logistic回归分析显示,肿瘤大小、浸润深度、NLR和CAR是术前诊断为cN0期胃癌患者术后淋巴结转移的独立危险因素,OR值分别为1.358、8.174、3.049和2.254。术前诊断cN0期胃癌患者淋巴结转移的指数预测模型表达式为h（t）=h0exp（1.358X₁+8.174X₂+3.049X₃+2.254X₄）。  结论  术前高PLR、NLR和CAR水平与患者淋巴结分期及淋巴结转移数量密切相关,术前高NLR和CAR水平是cN0期胃癌患者淋巴结转移的独立影响因素。      

The prognostic role of neutrophil-to-lymphocyte ratio and C-reactive protein in metastatic colorectal cancer using regorafenib: a systematic review and meta-analysis

BackgroundThe application of regorafenib has changed the landscape of subsequent-line treatment in metastatic colorectal cancer (mCRC). Baseline neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP), as two of the most common inflammatory factors, are suggested to be potential prognostic factors for mCRC patients treated with regorafenib, but the results are conflicting. In this study, we conducted a meta-analysis to evaluate the prognostic role of NLR and CRP in mCRC patients treated with regorafenib.MethodsWe searched online databases such as Embase, PubMed, and the Cochrane library up to April 2022, without language limitation, to identify clinical studies evaluating the prognostic role of NLR or CRP in regorafenib treated mCRC patients. The main endpoints were hazard ratio (HR) of overall survival (OS) and progression-free survival (PFS). The associations between NLR, CRP, and the above endpoints were extracted. Review Manager 5.4 was used to conduct the combined analysis. The Newcastle-Ottawa Scale (NOS) was applied for assessing the quality of included studies. Heterogeneity was detected by chi-square-based Q test and I² statistic, and publication bias was evaluated by funnel plot asymmetry and Egger’s test.ResultsEight studies involving 1,287 cases were included, with 5 reporting survival outcomes based on NLR level and 4 reporting survival according to CRP level. The results of meta-analysis showed that the calculated HR of OS for subsequent-line regorafenib in mCRC patients with high versus low NLR was 2.52 [I²=52%, 95% confidence interval (CI): 1.75–3.64; P<0.00001]. The combined HR of PFS with high versus low baseline NLR was 2.11 (I²=12%, 95% CI: 1.80–2.48; P<0.00001). For patients with a high level of CRP, the OS was significantly shorter when compared with patients with a low level of CRP (I²=0%, HR =1.88; 95% CI: 1.55–2.29; P<0.00001).ConclusionsHigh level of NLR could be associated with OS in mCRC patients treated with regorafenib. It is suggested that the impact of regorafenib on OS may vary according to the baseline NLR.     

High neutrophil-to-lymphocyte ratio following stereotactic body radiation therapy is associated with poor clinical outcomes in patients with borderline resectable and locally advanced pancreatic cancer

BackgroundThe purpose of this study is to report on the prognostic role of pre- and post-stereotactic body radiation therapy (SBRT) neutrophil-to-lymphocyte ratio (NLR) in a cohort of patients with borderline resectable (BRPC) and locally advanced pancreatic cancer (LAPC) who was treated with multi-agent induction chemotherapy followed by five-fraction SBRT.MethodsPatients treated with multi-agent induction chemotherapy followed by SBRT from August 2016 to January 2019 and who had laboratory values available for review were included in the study. Univariate (UVA) and multivariate analyses (MVA) were performed to determine associations between pre-/post-SBRT NLR and overall survival (OS), local progression-free survival (LPFS), distant metastasis-free survival (DMFS), and progression-free survival (PFS).ResultsA total of 156 patients were treated with multi-agent induction chemotherapy followed by SBRT and had laboratory values available for review. On UVA, chemotherapy duration ≥4 months, poorly differentiated disease, inability to undergo resection, pre-SBRT ANC ≥3.7 No./µL, pre-SBRT NLR ≥2.3, and post-SBRT NLR ≥2.6 were associated with worse OS. Patients with post-SBRT NLR ≥2.6 had a median OS of 16.7 months versus median OS not yet reached in patients with post-SBRT <2.6 (P=0.009). On MVA, poorly differentiated disease [hazard ratio (HR) =1.82, 95% CI: 1.04–3.18, P=0.035], inability to undergo resection (HR =2.17, 95% CI: 1.25–3.70, P=0.006), and post-SBRT NLR ≥2.6 (HR =2.55, 95% CI: 1.20–5.45, P=0.015) were associated with inferior OS. On UVA, baseline CA 19-9 ≥219 U/mL, pre-SBRT platelet count ≥157×1,000/µL, and post-SBRT NLR ≥2.6 were associated with inferior LPFS. Patients with post-SBRT NLR ≥2.6 had a median LPFS of 18.3 months versus median LPFS not yet reached in patients with post-SBRT <2.6 (P=0.028). On MVA, only post-SBRT NLR ≥2.6 was associated with worse LPFS (HR =3.22, 95% CI: 1.04–9.98, P=0.043).ConclusionsPost-SBRT NLR ≥2.6 predicted for inferior OS and LPFS in BRPC/LAPC patients treated with multi-agent chemotherapy and SBRT. These findings highlight the importance of further elucidating the immunologic effects of radiation therapy in this setting, which may have significant implications on both radiation design as well as combination strategies.     

Serum calcium improved systemic inflammation marker for predicting survival outcome in rectal cancer

BackgroundSystemic inflammation markers have shown prognostic values with variability in rectal cancer. Considering the association of serum calcium with inflammation, we aimed to examine whether it could improve systemic inflammation markers for survival prediction.MethodsWe enrolled 508 patients with stage I to III rectal cancer who underwent curative resection. The cohort was grouped by corrected serum calcium (cCa), platelet-to-lymphocyte ratio (PLR), and CaPLR (a score model combining cCa with PLR) for survival analysis. The LR (likelihood ratio) test and AIC (Akaike information criterion) were applied to compare models in survival prediction. The primary endpoint was disease-free survival (DFS).ResultsA total of 26.7% (136/508) patients reached recurrence after curative surgery. Both high cCa (HR 1.486; 95% CI, 1.018–2.171; P=0.040) and high PLR (HR 1.452; 95% CI, 1.059–1.991; P=0.021) were significantly associated with worse DFS. In model comparison, the AIC and LR were improved after cCa was added to PLR model in DFS prediction (AIC: 1,704.83 vs. 1,707.14 vs. 1,707.15; LR: 8.68 vs. 4.37 vs. 4.36; P=0.037). The CaPLR was developed for DFS prediction with adjusted HRs of 2.216 (95% CI, 1.256–3.909; P=0.006) and 1.679 (95% CI, 1.004–2.836; P=0.047) for high and intermediate score group respectively compared to low score group. A nomogram for predicting DFS was generated by using CaPLR and other clinical predictors, with a concordance index of 0.705 (95% CI, 0.620–0.789; P<0.001).ConclusionsSerum calcium could improve systemic inflammation markers in survival prediction for patients with rectal cancer.     

外周血炎症指标与非小细胞肺癌EGFR突变的相关性

目的:研究非小细胞肺癌（non-small cell lung cancer,NSCLC）患者表皮生长因子受体（epidermal growth factor receptor,EGFR）基因突变与中性粒细胞与淋巴细胞比值（NLR）、淋巴细胞与单核细胞比值（LMR）、系统性炎症反应指数（SIRI）三种炎性指标及患者临床病理学特征的相关性。方法:通过回顾性分析的方法比较136例非小细胞肺癌患者EGFR突变型与野生型在各项临床指标、外周血三种免疫细胞及炎症指标上的差异。结果:EGFR野生型患者与突变型患者在性别、吸烟史、病理类型上比较,差异有统计学意义（P＜0.05）。EGFR突变型相较于野生型以未吸烟、女性患者、腺癌患者居多。EGFR野生型与突变型在NLR、LMR、SIRI上差异有统计学意义（P＜0.05）。EGFR突变型患者治疗前LMR高于野生型患者,EGFR突变型患者治疗前NLR和SIRI低于野生型患者。结论:炎症指标LMR、NLR、SIRI与NSCLC患者EGFR突变具有相关性。LMR对EGFR突变有一定的预测价值,且优于SIRI与NLR。     

Analysis of local chronic inflammatory cell infiltrate combined with systemic inflammation improves prognostication in stage II colon cancer independent of standard clinicopathologic criteria

In Stage II colon cancer, multiple independent studies have shown that a dense intratumoural immune infiltrate (local inflammation) is associated with improved outcomes, while systemic inflammation, measured by various markers, has been associated with poorer outcomes. However, previous studies have not considered the interaction between local and systemic inflammation, nor have they assessed the type of inflammatory response compared with standard clinicopathologic criteria. In order to evaluate the potential clinical utility of inflammatory markers in Stage II colon cancer, we examined local and systemic inflammation in a consecutive series of patients with resected Stage II colon cancer between 2000 and 2010 who were identified from a prospective clinical database. Increased intratumoural chronic inflammatory cell (CIC) density, as assessed by pathologist review of hematoxylin and eosin stained slides, was used to represent local inflammation. Neutrophil‐to‐lymphocyte ratio (NLR) >5, as calculated from pre‐operative full blood counts, was used to represent systemic inflammation. In 396 eligible patients identified, there was a non‐significant inverse relationship between local and systemic inflammation. Increased CIC density was significantly associated with improved overall (HR 0.45, p = 0.001) and recurrence‐free survival (HR 0.37, p = 0.003). High NLR was significantly associated with poorer overall survival (HR 2.56, p < 0.001). The combination of these markers further stratified prognosis independent of standard high‐risk criteria, with a dominant systemic inflammatory response (low CIC/high NLR) associated with the worst outcome (5‐year overall survival 55.8%). With further validation this simple, inexpensive combined inflammatory biomarker might assist in patient selection for adjuvant chemotherapy in Stage II colon cancer.     

Prognostic role of pretreatment blood neutrophil-to-lymphocyte ratio in advanced cancer survivors: A systematic review and meta-analysis of 66 cohort studies

BackgroundNeutrophil-to-lymphocyte ratio (NLR) is crucial for the incidence and mortality of various tumors. However, little is known on NLR and its association with prognosis in advanced tumors. Here we performed a meta-analysis to establish the prognostic significance of pretreatment blood NLR for advanced tumors.MethodsA systematic literature search through April 2016 was performed to evaluate the association between pretreatment blood NLR and overall survival (OS) or progression-free survival (PFS) in patients with advanced tumors. Data were extracted from studies reporting hazard ratios (HRs) and 95% confidence interval (CI) and pooled using the Mantel–Haenszel random-effect model.ResultsSixty-six studies with a total of 24536 individuals were included in the meta-analysis. Pooled analyses revealed that elevated pretreatment NLR was associated with worse OS (HR 1.70, 95% CI 1.57–1.84, P < 0.001) and PFS (HR 1.61, 95% CI 1.42–1.82, P < 0.001) in advanced tumors. Subgroup analysis stratified by tumor type demonstrated that pancreatic cancer patients with high pretreatment NLR had the worst OS (HR 1.94, 95% CI 1.55–2.54, P < 0.001) and colorectal cancer with the worst PFS (HR 1.74, 95% CI 1.04–2.90, P < 0.001). When stratified by cut-off value for NLR, we found that cut-off value being five indicated the worst PFS (HR 2.23, 95% CI 1.54–3.23, P = 0.019).ConclusionsOverall, high pretreatment blood NLR could be an adverse prognostic indicator for advanced tumor. Large-scale prospective studies investigating its survival outcomes in specific cancer type are strongly advocated.     

弥漫性大B细胞淋巴瘤患者外周血NLR、PLR以及LDH的水平及其临床意义

目的:研究弥漫性大B细胞淋巴瘤患者外周血中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）及乳酸脱氢酶（LDH）与健康人的差异、不同分期之间的差异,以及三者联合检测的诊断价值。方法:收集我院血液科2018年10月至 2020年10月收治的81例DLBCL患者作为实验组,同期85例健康体检者作为对照组,根据Ann Arbor分期标准将淋巴瘤组患者分为Ⅰ-Ⅱ期（n=27）、Ⅲ-Ⅳ期（n=54）,测定外周血NLR、PLR及LDH水平,对比两组及不同分期之间是否存在差异;建立受试者工作特征（ROC）曲线,通过分析曲线下面积（AUC）,对比NLR、PLR、LDH以及三者联合对DLBCL的诊断价值。结果:淋巴瘤组81例,NLR、PLR、LDH分别为（3.65±2.55）、（207.73±11.01）、（371.79±63.56）ng/mL,均显著高于对照组（1.96±0.62 ,P＜0.05）、（127.88±41.05,P＜0.05）、（151.99±43.72,P＜0.05）ng/mL,两组之间差异有统计学意义。与Ⅰ-Ⅱ期患者的NLR（3.00±1.63）、PLR（172.99±61.87）、LDH（279.15±19.12）ng/mL水平对比,Ⅲ-Ⅳ期患者NLR（3.98±2.86）、PLR（225.10±25.71）、LDH（418.11±23.83）ng/mL的水平均显著升高,差异有统计学意义（P=0.045,P=0.014,P=0.011）。ROC曲线:NLR以2.44为临界值时对DLBCL的诊断灵敏度、特异性、准确度分别为69.1%、78.8%、74.1%,PLR以168.64为临界值时对DLBCL的诊断灵敏度、特异性、准确度分别为61.7%、87.1%、74.7%,LDH以186.50 ng/mL为临界值时对DLBCL的诊断灵敏度、特异性、准确度分别为75.3%、94.1%、84.9%,三者联合时分别为 80.2%、91.8%、85.5%。四种方法特异度的差异有统计学意义（P=0.022）,灵敏度、准确度的差异无统计学意义（P=0.054,P=0.133）。两两比较发现,三者联合的灵敏度高于PLR单独检测（P=0.009）,特异性高于NLR单独检测（P=0.027）。NLR、PLR、LDH的曲线下面积分别为0.78、0.788、0.866,三者联合为0.916,显著高于三者单独检测（P＜0.05）。结论:与健康人对比,NLR、PLR及LDH在弥漫性大B细胞淋巴瘤患者中显著升高,且与分期有关,三者联合检测可以显著提高对DLBCL的诊断价值。     

大肠癌患者4种淋巴细胞表型的测定及其意义

背景与目的:机体淋巴细胞的功能状态与肿瘤的发生、发展过程密切相关。而淋巴细胞表面众多而复杂的膜蛋白是淋巴细胞膜信号传递、激活、凋亡等细胞分化调控机制重要的分子生物学基础。本研究探讨了大肠癌患者外周血淋巴细胞(peripheralbloodlymphocytes,PBL)CD8、CD28、CD49b、CD49d4种表型变化及其肿瘤生物学行为的关系。方法:应用CD8、CD28、CD49b、CD49d单克隆抗体,采用流式细胞术,对35例大肠癌患者(肿瘤组)及30例同期非肿瘤患者(对照组)的PBL上述4种表型进行监测。结果:肿瘤组淋巴细胞CD8的表达为(30.89±6.54)%,对照组的表达为(20.82±5.15)%,肿瘤组显著高于对照组(P<0.01);肿瘤组CD28、CD8+/CD28+及CD49b、CD49d的表达分别为(42.04±8.83)%、(9.29±2.81)%及(22.77±10.46)%、(65.59±13.15)%,对照组的表达分别为(56.05±7.32)%、(14.91±2.58)%及(33.18±17.18)%、(83.61±9.14)%,肿瘤组的表达显著低于对照组P均<0.05)。DukesD期大肠癌组CD8+/CD28+、CD49b、CD49d的表达分别为(7.62±1.63)%、(18.53±9.59)%、(59.85±16.18)%,DukesB期组的表达分别为(10.01±2.90)%、(9.60±11.01)%、(73.12±10.86)%,DukesD期大肠癌组的表达明显低于DukesB期组(P<0.05);淋巴结转移组CD28、CD8+/CD28+及CD49b、C