NLR、LMR和PLR与骨肉瘤预后的关系

目的 探讨术前中性粒细胞/淋巴细胞比值(NLR)、淋巴细胞/单核细胞比值(LMR)、血小板/淋巴细胞比值(PLR)对预测骨肉瘤患者预后的影响.方法 回顾性分析接受同样治疗方案的70例骨肉瘤患者的临床和生存资料,计算出初次确诊为骨肉瘤时的NLR、PLR和LMR,ROC曲线分析NLR、PLR和LMR的AUC值并确定最佳预测...     

转移性结直肠癌维持治疗研究进展

结直肠癌是最常见的恶性肿瘤之一。近年来,奥沙利铂、5-FU类制剂、伊立替康、VEGF抗体、EGFR抑制剂等药物的使用延长了晚期结直肠癌患者的5年生存率,显著改善患者的生活质量。维持治疗是指对一线治疗后获益的患者,停用某些毒副反应较大的药物,保留低毒性药物继续治疗的一种治疗模式。因此,一些临床研究评估了上述药物在转移性结直肠癌患者一线治疗获益后的维持治疗的疗效及安全性。本文就转移性结直肠癌维持治疗方案的临床研究作一综述,全面地了解转移性结直肠癌维持治疗的相关进展。     

术前NLR与PLR对结直肠癌预后的意义

目的研究术前外周血中中性粒细胞、淋巴细胞、血小板的相互比值与结直肠癌预后之间的相关性。方法收集2011年1月至2015年12月在延边大学附属医院行结直肠癌根治性手术的417例患者的临床、病理学资料,分析中性粒细胞、淋巴细胞、血小板与结直肠癌预后指标之间的相关性。结果中性粒细胞和淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)与TNM分期、T分期、N分期之间差异有统计学意义(P0.05),与M分期之间差异无统计学意义(P0.05),NLR≤1.57组和NLR1.57组的5年生存率分别为77.14%、20.78%,两组间差异有统计学意义(P0.05);血小板和淋巴细胞比值(platelet to lymphocyteratio ratio,PLR)与TNM分期、T分期、N分期、M分期之间差异均无统计学意义(P0.05)。结论术前NLR可有效评估结直肠癌预后,为结直肠癌患者及临床治疗提供预后指标。     

血清AFR、FPR及NLR与早期结直肠癌患者术后辅助化疗疗效及预后的关系

目的 探讨血清白蛋白/纤维蛋白原比值(AFR)、纤维蛋白原/前白蛋白比值(FPR)及中性粒细胞计数与淋巴细胞计数比值(NLR)与早期结直肠癌患者术后辅助化疗疗效及预后的关系。方法 选取结直肠癌患者95例,治疗后根据临床疗效分为有效组和无效组,比较2组患者年龄、临床分期、组织学分型、肿瘤部位、AFR、FPR、NLR、淋巴结转移、肿瘤大小、分化程度等资料。再根据随访预后情况将有效组患者分为疾病进展组和疾病未进展组,比较2组患者不同病理资料。结果 患者经手术辅助化疗后,CR 56例,PR 22例,SD 15例,PD 2例,其中有效共78例(82.1%)。有效组与无效组患者年龄、临床分期、AFR、FPR、NLR、淋巴结转移、分化程度差异均具有统计学意义(P<0.05)。患者年龄、临床分期、AFR、FPR、NLR、淋巴结转移、分化程度是早期结直肠癌术后辅助化疗临床疗效的影响因素。随访18个月,有效组患者中疾病进展患者24例(30.8%),疾病进展组与疾病未进展组患者在年龄、临床分期、AFR、FPR、NLR、淋巴结转移、肿瘤大小、分化程度方面的差异均具有统计学意义(P<0.05)。患者...     

术前 NLR 对同时性结直肠癌肝转移患者的预后价值

目的 探讨术前中性粒细胞/ 淋巴细胞比值(NLR)和癌胚抗原(CEA)对同时性结直肠癌肝转移患者的预后价值。方法 回顾性收集 2012 年 8 月至 2017 年 12 月期间在河北北方学院附属第一医院行同期肝切除的同时性结直肠癌肝转移患者的临床病理资料,使用 X-TILE 软件来计算 NLR 的最佳截止点;采用 Kaplan-Meier 生存曲线和 Log-rank 检验来绘制和比较生存曲线,利用 Cox 比例风险回归模型来分析独立预后因素;采用时间依赖性曲线下面积( t-AUC)来绘制和比较不同指标联合使用时的预后价值。 结果 共有 122 例同时性结直肠癌肝转移患者被纳入此研究,NLR 进行预后分层时的最佳截止点为2. 1,术前较高的 NLR 和更高的病理 T 分期相关(P= 0. 037),但与低 NLR 组相比在其他指标上均无明显差异(P>0. 05);单因素生存分析提示术前 NLR 水平、最大肝转移直径、结直肠癌 pT 分期、是否淋巴结转移和术前 CEA 水平与同时性结直肠癌肝转移患者的预后相关(P 均<0. 05);多因素生存分析肝转移数目(HR = 1. 644,95%CI = 1. 063 ~ 2. 542,P = 0. 025)、有淋巴结转移(HR= 1. 76,95%CI = 1. 045~ 2. 965,P= 0. 034)、CEA≥3. 4 μg / L(HR= 1. 611,95%CI = 1. 054 ~ 2. 460,P = 0. 028),以及 NLR≥2. 1(HR= 1. 625,95%CI = 1. 044~ 2. 539,P= 0. 033)是同时性结直肠癌肝转移患者预后的独立危险因素。 NLR 在预测患者预后时的 t-AUC 为 60. 89% ~ 66. 41%,CEA 为 58. 15% ~ 66. 41%,联合检测时的 t-AUC 为 64. 53% ~ 68. 36%,CEA 在预测患者预后时的 C-index 为 0. 648(95%CI = 0. 543~ 0. 752),NLR 为 0. 688(95%CI = 0. 583 ~ 0. 795),二者相比无明显差异(P = 0. 29),联合检测时 C-index 可提高到 0. 69(95%CI = 0. 586~ 0. 795),但对比单独使用 CEA(P = 0. 12)或 NLR(P = 0. 52)时均无统计学差异。 结论 术前 NLR 或 CEA 升高与同时性结直肠癌肝转移患者的不良预后密切相关,联合应用术前 NLR 和 CEA 可提高对患者预后预测的准确性。     

LMR、NLR与肺癌患者病理分型及免疫治疗疗效的关系研究

目的 探讨淋巴细胞/单核细胞比值(LMR)、中性粒细胞/淋巴细胞比值(NLR)与肺癌患者病理分型及免疫治疗疗效的关系。方法 收集2019年1月至2021年1月在苏州大学附属第二医院肿瘤科经病理明确且无法手术的肺癌患者为研究对象,共200例,为研究组,同期于医院进行体检的100例健康志愿者定义为对照组。比较研究组、对照组LMR、NLR。肺癌患者入院后均接受一线化疗联合分子靶向药物免疫治疗,于治疗4周期后评估免疫治疗疗效,比较疾病控制肺癌患者、疾病进展肺癌患者LMR、NLR。绘制受试者工作特征曲线(ROC)分析LMR、NLR预测肺癌患者免疫治疗疗效的最佳临界值,根据最佳临界值将200例肺癌患者分为高LMR组、低LMR组,高NLR组、低NLR组,收集肺癌患者临床资料,分析LMR、NLR与肺癌患者病理分型及免疫治疗疗效的关系。结果 研究组LMR、NLR均高于对照组,组间差异有统计学意义(P<0.05)。疾病控制组肺癌患者LMR、NLR均低于疾病进展肺癌患者,差异具有统计学意义(P<0.05)。ROC曲线结果显示,LMR、NLR预测肺癌患者免疫治疗疗效的最佳截断值分别为6.27、3....     

转移性结直肠癌维持治疗的研究现状与治疗策略

结直肠癌是常见的恶性肿瘤之一,其发病率和死亡率分别位于第三位和第四位。大约60%的患者确诊时已处于晚期,其5年生存率在13%左右。近20年来,由于转移性结直肠癌(mCRC)晚期一线化疗方案及靶向药物的规范化应用,mCRC的治疗获得了重大突破。奥沙利铂、卡培他滨、贝伐珠单抗、西妥昔单抗等药物的应用使患者的中位生存期提高了一倍,5年生存率提高了20%。mCRC晚期一线治疗的常规模式是持续用药,直至病情进展或出现不可耐受的毒性。但是由于化疗药物的毒性累积,只有三分之一的患者能够坚持接受治疗直至病情进展。而患者在完成既定的初始化疗周期数,达到CR/PR/SD后,继续采用低剂量、低毒性的药物进行维持治疗,既可以延缓肿瘤的进展和转移,又可以减轻药物的毒副作用。目前,维持治疗已经成为mCRC晚期一线化疗后的主要治疗模式。但是,mCRC的最佳维持治疗方案仍无定论,现有的维持治疗方案仍不能找到最佳疗效与最大生活质量之间的平衡点。本文将回顾mCRC现有的维持治疗方案的临床研究,总结mCRC维持治疗现状,并对个体化的治疗策略进行讨论。     

术前外周血NLR、PLR、LMR和SII对喉鳞癌的诊断价值研究

目的 探讨术前外周血中性粒细胞与淋巴细胞比值(neutrophile-to-lymphocyte rate,NLR)、血小板与淋巴细胞比值(platelet-to-lymphocyte ratio,PLR)、淋巴细胞与单核细胞比值(lymphocyte-to-monocyte ratio,LMR)与系统性免疫性炎性反应...     

NLR、PLR、LMR与126例食管小细胞癌临床病理特征及预后的关系分析

[目的]探讨食管小细胞癌（small cell carcinoma of the esophagus,SCCE）术后中性粒细胞/淋巴细胞比值（neutrophil/lymphocyte ratio,NLR）、血小板/淋巴细胞比值（platelet/lymphocyte ratio,PLR）、淋巴细胞/单核细胞比值（lymphocyte/monocyte ratio,LMR）与临床病理特征及预后的相关性。[方法]回顾性分析河北省肿瘤医院收治的126例SCCE手术患者,分析NLR、PLR、LMR与SCCE临床病理特征及预后的关系。[结果]术后SCCE患者中NLR与肿瘤大小、局部浸润深度、淋巴结转移和TNM分期相关;PLR与局部浸润深度、淋巴结转移、远处转移和TNM分期相关;LMR与局部浸润深度、远处转移和TNM分期相关。单因素分析显示：肿瘤大小、局部浸润深度、淋巴结转移、远处转移、TNM分期、NLR、PLR和LMR水平与预后相关。多因素Cox回归分析显示：NLR、PLR、LMR、远处转移和TNM分期是SCCE患者的独立预后因素,高NLR组、高PLR组和低LMR组患者预后较差。[结论] NL...     

NLR和LMR对EGFR-TKIs治疗EGFR突变阳性非小细胞肺癌预后的预测价值

目的:探讨治疗前血清中性粒细胞与淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)和淋巴细胞与单核细胞比值(lympho cyte to monocyte ratio,LMR)对表皮生长因子受体-酪氨酸激酶抑制剂(epidermal growth factor receptor-tyr...     

Time-varying prognostic value of primary tumor sidedness in metastatic colorectal cancer: A population-based study and meta-analysis

We studied the prognostic value of primary tumor sidedness in metastatic colorectal cancer over time and across treatment lines. Population data on synchronous metastatic colorectal cancer patients were extracted from the Netherlands Cancer Registry and SEER database. Pubmed, EMBASE and Cochrane library were searched for prospective studies on metastatic colorectal cancer to conduct a meta-analysis. Inclusion criteria consisted of metastatic disease, systemic treatment with palliative intent and specification of primary tumor location. Data were pooled using a random-effects model. For the population-based data, multivariable Cox models were constructed. The Grambsch-Therneau test was conducted to evaluate the potential time-varying nature of sidedness. Meta-regression incorporating treatment-line as variable was conducted to test the pre-specified hypothesis that the prognostic value of sidedness varies over time. Analysis of 12 885 and 16 160 synchronous metastatic colorectal cancer patients registered in the Netherlands Cancer Registry and SEER database, respectively, indicated a time-varying prognostic value of sidedness (P < .01). Thirty-one studies were selected for the meta-analysis (9558 patients for overall survival analysis). Pooled univariable hazard ratio_{left-sided/right-sided} for overall survival was 0.71 (95% CI: 0.65-0.76) in 1st-line, 0.76 (0.54-1.06) in 2nd-line and 1.01 (0.86-1.19) in 3rd-line studies. Hazard ratios were significantly influenced by treatment line (P = .035). The prognostic value of sidedness of the primary tumor in metastatic colorectal cancer patients treated with palliative systemic therapy decreases over time since diagnosis, suggesting that sidedness may not be a useful stratification factor in late-line trials. This decrease in prognostic value should be taken into account when providing prognostic information to patients.     

维持治疗在晚期结直肠癌化疗后达稳定患者中的价值及预后分析*

目的：探讨晚期结直肠癌姑息化疗后获得疾病稳定患者的预后异质性及个体化治疗策略的应用。方法：研究收集2008年4 月至2014年10月204 例在天津医科大学肿瘤医院接受标准一线和（或）二线化疗后获得疾病稳定的晚期结直肠癌患者,分析该人群临床病理特征,筛选预后异质性分层因子,并评估姑息化疗后治疗手段（即单纯观察或维持治疗）对于特殊人群的影响。结果：单因素生存分析表明化疗线数、基线CA724、CEA 、CA19- 9 水平、血小板淋巴细胞比率（PLR ）、姑息化疗后治疗手段为预后影响因素。多因素Cox 比例风险回归模型分析显示,一线化疗、基线CA19- 9 低水平、PLR 低水平、姑息化疗后维持治疗患者预后较好。亚组分析显示PLR 高水平患者中,维持治疗组与观察组无进展生存期分别为13.43个月和10.63个月（P = 0.003）。 结论：基线CA19- 9、PLR 水平及姑息化疗后治疗手段为获得疾病稳定的晚期结直肠癌患者的独立预后因子。疾病稳定人群尤其是PLR 高水平者宜接受维持治疗。     

Bevacizumab in combination with biweekly capecitabine and irinotecan, as first-line treatment for patients with metastatic colorectal cancer

Background:

Combination of capecitabine and irinotecan (XELIRI regimen) is an active and well tolerated treatment for metastatic colorectal cancer (mCRC). The aim of this study was to evaluate the efficacy and safety of this regimen in combination with bevacizumab (BV), as first-line treatment for mCRC.

Patients and methods:

A total of 46 consecutive patients received a combination of BV (5 mg kg⁻¹, day 1), irinotecan (175 mg m⁻², day 1) and capecitabine (1000 mg m⁻² twice daily on day 2–8), every 2 weeks. Patients were treated until disease progression or unacceptable toxicity. The primary objective was to determine the progression-free survival (PFS) and safety profile.

Results:

The overall response rate (ORR) was 67.4%, with a disease control rate (ORR+stable disease) of 93.5%. Median PFS and overall survival (OS) were 12.3 months (95% confidence interval (CI): 6.5–18.1 months) and 23.7 months (95% CI: 16.7–30.6 months), respectively. The most frequent grade 3/4 treatment-related adverse events were asthenia (7%), diarrhoea (7%), nausea (9%) and vomiting (7%).

Conclusion:

Bevacizumab combined with biweekly XELIRI is a highly active first-line regimen for mCRC treatment, showing encouraging PFS, ORR and OS with a good tolerability.     

西妥昔单抗联合化疗治疗转移性结直肠癌疗效与K-ras状态的关系

背景与目的：随着西妥昔单抗联合化疗在转移性结直肠癌患者中的不断应用,预测其治疗疗效的研究也越来越深入。本文旨在探讨转移性结直肠癌患者肿瘤组织中K—ras基因表达状态（野生型或突变型）及其与西妥昔单抗联合化疗疗效之间的关系。方法：2006年3月02008年6月期间应用西妥昔单抗联合化疗治疗转移性结直肠癌27例。采用聚合酶链反应（PCR）技术和直接测序法检测肿瘤组织中K-ras基因表达状态。分析K—ras基因表达状态与西妥昔单抗联合化疗疗效之间的关系。结果：全组27例患者中,K-ras野生型15例（55．6％）,K—FaS突变型12例（44．4％）。在K—FaS野生型中,西妥昔单抗联合化疗的总有效率（ORR）为66．7％,其中cR2例（13．3％）,PR 8例（53．3％）,中位无进展生存期（PFS）8个月。在K—ras突变型中,总有效率为25．0％,PR3例（25．0％）,中位PFS4个月。在K—ras野生型转移性结直肠癌患者中应用西妥昔单抗联合化疗的疗效明显优于K—ras突变型患者。结论：K-ras野生型是西妥昔单抗联合化疗疗效良好的预测指标。在西妥昔单抗联合化疗前明确患者的K—ras基因状态有助于选择合适的患者,获得最佳疗效。     

Real-world effectiveness of regorafenib in the treatment of patients with metastatic colorectal cancer: A retrospective,observational study

Aim

To evaluate the real-world usage pattern and factors associated with the effectiveness of regorafenib in patients with metastatic colorectal cancer (mCRC).

Methods

This retrospective study analyzed data for 209 patients with mCRC treated with regorafenib as third or later line of therapy. TheKaplan–Meier method was used to draw the survival curves. Cox proportional hazard regression models were used to analyze the prognostic value for overall survival (OS).

Results

Of 209 patients, 156 (75%) were treated with regorafenib, and 53 (25%) were given regorafenib combined with programmed cell death-1 (PD-1) inhibitors. About 182 (87%) patients had a dose record of regorafenib. The initial daily doses of regorafenib were 160, 120, 80, and 40 mg, accounting for 29%, 17%, 48%, and 6% of patients, respectively. The median follow-up time was 11.3 months, and the median OS was 12.0 months (95% CI: 9.7–14.3). Patients treated with PD-1 inhibitors plus regorafenib had a longer OS than the non-PD-1 group (13.5 vs. 10.1 months, hazard ratio [HR] = .534, 95% CI: .325–.879; p = .014). A total of 49 patients with microsatellite stable or mismatch repair-proficient genotype treated with PD-1 inhibitors plus regorafenib had a longer OS than the non-PD-1 group (13.5 vs. 9.7 months; HR = .563, p = .027). The median OS of patients continuing treatment with regorafenib after progression (n = 19, with five patients receiving additional immunotherapy) was marginally longer than patients discontinuing regorafenib after progression (12.7 vs. 11.9 months, p = .425) observed in a smaller cohort.

Conclusion

In real-world practice, patients with mCRC in whom standard regimens had failed have a good survival benefit with regorafenib. Combination with PD-1 inhibitor may further prolong survival of the patients.     

Prognostic and predictive impact of metastatic organ involvement on maintenance therapy in advanced metastatic colorectal cancer: Subgroup analysis of patients treated within the PanaMa trial (AIO KRK 0212)

Despite molecular selection, patients (pts) with RAS wildtype mCRC represent a heterogeneous population including diversity in metastatic spread. We investigated metastatic patterns for their prognostic and predictive impact on maintenance therapy with 5-fluorouracil/folinic acid ± panitumumab. The study population was stratified according to (1) number of involved metastatic sites (single vs multiple organ metastasis), liver-limited disease vs (2) liver metastasis plus one additional site, and (3) vs liver metastasis plus ≥two additional sites. Kaplan-Meier method and Cox regressions were used to correlate efficacy endpoints. Single organ metastasis was observed in 133 pts (53.6%) with 102 pts (41.1%) presenting with liver-limited disease, while multiple organ metastases were reported in 114 pts (46.0). Multiple compared to single organ metastases were associated with less favorable PFS (HR 1.48, 95% CI 1.13-1.93; P = .004) and OS (HR 1.37, 95% CI 0.98-1.93; P = .068) of maintenance therapy. While metastatic spread involving one additional extrahepatic site was not associated with clearly impaired survival compared to liver-limited disease, pts with liver metastasis plus ≥two additional sites demonstrated less favorable PFS (HR 1.92, 95% CI 1.30-2.83; P < .001), and OS (HR 2.38, 95% CI 1.51-3.76; P < .001) of maintenance therapy. Pmab-containing maintenance therapy appeared active in both pts with multiple (HR 0.58; 95% CI, 0.39-0.86; P = .006) as well as to a lesser numerical extent in pts with single organ metastasis (HR 0.83; 95% CI, 0.57-1.21; P = .332; Interaction P = .183). These data may support clinical decisions when EGFR-based maintenance therapy is considered.