外周血中性粒细胞与淋巴细胞比值与初诊晚期非小细胞肺癌患者预后的关系研究

背景多数非小细胞肺癌(NSCLC)患者预后并不十分理想,而目前关于外周血中性粒细胞与淋巴细胞比值(NLR)与初诊晚期NSCLS患者预后关系的研究报道较少见。目的探讨外周血NLR与初诊晚期NSCLC患者预后的关系。方法选取2014-2015年徐州医科大学第二附属医院收治的初诊晚期NSCLC患者83例,根据存活情况分为存活组8例与死亡组75例。通过ROC曲线确定外周血NLR预测初诊晚期NSCLC患者预后的最佳临界值,比较存活组与死亡组患者临床特征及NLR,采用多元Cox比例风险回归分析初诊晚期NSCLC患者预后的影响因素。根据外周血NLR预测初诊晚期NSCLC患者预后的最佳临界值将所有患者分为低NLR组34例与高NLR组49例,比较低NLR组与高NLR组患者临床特征;绘制Kaplan-Meier生存曲线以比较低NLR组与高NLR组患者生存情况。结果(1)ROC曲线显示,外周血NLR预测初诊晚期NSCLC患者预后的曲线下面积(AUC)为0.788[95%CI(0.716,0.832)],最佳临界值为2.73。(2)存活组与死亡组患者TNM分期、组织分化程度、器官转移发生率、NLR比较,差异有统计学意义(P<0.05);两组患者男性比例、年龄、吸烟率、肿瘤类型及病理类型比较,差异无统计学意义(P>0.05)。(3)多元Cox比例风险回归分析结果显示,TNM分期、组织分化程度、外周血NLR是初诊晚期NSCLC患者预后的独立影响因素(P<0.05)。(4)低NLR组与高NLR组患者TNM分期、组织分化程度、器官转移发生率比较,差异有统计学意义(P<0.05);两组患者男性比例、年龄、吸烟率、肿瘤类型、病理类型比较,差异无统计学意义(P>0.05)(5)Kaplan-Meier生存曲线显示,高NLR组患者3年累积生存率低于低NLR组(P<0.05)。结论外周血NLR是初诊晚期NSCLC患者预后的独立影响因素,外周血NLR升高(≥2.73)的初诊晚期NSCLC患者的生存期较短。

Relationship between Peripheral Blood Neutrophils to Lymphocytes Ratio and Prognosis in Patients with Newly Diagnosed Advanced NSCLC

Background The prognosis is not yet ideal in most of patients with non-small cell lung cancer(NSCLC),however there are few reports about relationship between peripheral blood neutrophils to lymphocytes ratio(NLR)and prognosis in patients with newly diagnosed advanced NSCLC so far. Objective To investigate the relationship between peripheral blood NLR and prognosis in patients with newly diagnosed advanced NSCLC. Methods A total of 83 patients with newly diagnosed advanced NSCLC were selected in the Second Affiliated Hospital of Xuzhou Medical University from 2014 to 2015,and they were divided into survival group(n=8)and death group(n=75) according to survival status. ROC curve was used to determine the optimum critical value of peripheral blood NLR in predicting prognosis in patients with newly diagnosed advanced NSCLC,clinical features and NLR were compared between survival group and death group,and influencing factors of prognosis in patients with newly diagnosed advanced NSCLC were analyzed by multivariate Cox proportional hazards regression analysis. All of the patients were divided into low-NLR group(n=34)and high-NLR group(n=49)according to the optimum critical value of peripheral blood NLR in predicting prognosis in patients with newly diagnosed advanced NSCLC,clinical features were compared between low-NLR group and high-NLR group,and Kaplan-Meier survivorship curve was used to analyze the survival status between low-NLR group and high-NLR group. Results(1)ROC curve analysis results showed that,AUC and optimum critical value of peripheral blood NLR in predicting prognosis in patients with newly diagnosed advanced NSCLC was 0.788 [95%CI(0.716,0.832)] and 2.73,respectively.(2)There were statistically significant differences in TNM stage,degree of tissue differentiation,incidence of organ metastasis and NLR between survival group and death group(P<0.05),while no statistically significant difference of male ratio,age,smoking rate,tumor types or pathological types was found between the two groups(P>0.05).(3)Multivariate Cox proportional hazards regression analysis results showed that,TNM stage,degree of tissue differentiation and peripheral blood NLR were independent influencing factors of prognosis in patients with newly diagnosed advanced NSCLC(P<0.05).(4)There were statistically significant differences in TNM stage,degree of tissue differentiation and incidence of organ metastasis between low-NLR group and high-NLR group(P<0.05),while no statistically significant difference in male ratio,age,smoking rate,tumor types or pathological types was found between the two groups(P>0.05).(5)Kaplan-Meier survivorship curve showed that,3-year cumulative survival rate in high-NLR group was statistically significantly lower than that in low-NLR group(P<0.05). Conclusion Peripheral blood NLR is one of independent influencing factors of prognosis in patients with newly diagnosed advanced NSCLC,survival time is relatively in newly diagnosed advanced NSCLC patients with high peripheral blood(≥ 2.73).