术前外周血NLR对上皮性卵巢癌患者预后的影响

  目的   评价术前外周血中性粒细胞/淋巴细胞比值（neutrophit-to-lymphocyte ratio，NLR），对上皮性卵巢癌患者预后的预测意义。   方法   回顾性分析天津医科大学肿瘤医院80例上皮性卵巢癌患者的临床病理资料，通过建立受试者工作特征曲线（ROC曲线），确定术前外周血NLR预测术后生存的最佳截点，以此将患者分为低NLR和高NLR两组，分析NLR与患者的临床病理特征之间的关系，并通过单因素及多因素分析评估术前外周血NLR对患者术后生存的影响。通过免疫组织化学法验证术前NLR与肿瘤相关巨噬细胞浸润的关系。   结果   术前NLR预测患者术后生存时间的最佳截点为3.8。术前低NLR组（NLR≤3.8）与高NLR组（NLR > 3.8）患者在FIGO分期的差异有统计学意义（P < 0.005），而在其他的各项临床病理特征间差异均无统计学意义。80例上皮性卵巢癌术后中位生存时间为45个月，术后1、3年生存率分别为93.7%、60.0%。单因素分析结果显示:术前NLR > 3.8（P < 0.005）及术后FIGO分期为Ⅲ~Ⅳ期（P < 0.005）是影响患者术后总体生存以及无瘤生存期的危险因素。多因素分析显示:术前NLR > 3.8（P < 0.05）及术后FIGO分期为Ⅲ~Ⅳ期（P < 0.05）为上皮性卵巢癌患者术后预后不良的独立危险因素。免疫组织化学法表明肿瘤相关巨噬细胞在术前高NLR组54.65±8.78与低NLR组41.78±9.10之间的差异有统计学意义（P < 0.001）。   结论   术前NLR升高提示患者预后不良，是影响上皮性卵巢癌患者预后的独立危险因素。 

Preoperative blood neutrophil to lymphocyte ratio as an independent prognostic predictor for epithelial ovarian cancer

  Objective   This study aims to evaluate the effect of an elevated preoperative neutrophil to lymphocyte ratio (NLR) on outcome after comprehensive staging laparotomy or optimal tumor debulking surgery for epithelial ovarian cancer (EOC) and determine the value of the NLR as an independent prognostic prediction marker.   Methods   A total of 80 women with primary EOC and with complete clinical and pathological information documented at the time of surgery were selected for this study. The optimum cut-off value of the preoperative NLR was identified through receiver operator characteristic (ROC) curve, and the patients were then classified into two groups: low and high NLR group. Univariate and multivariate analyses were performed to assess the prognostic effect of the preoperative NLR patients who underwent comprehensive staging laparotomy or optimal tumor debulking surgery. The levels of expression of CD68 were measured through immunohistochemistry.   Results   The optimal cut-off value of the NLR was 3.8. The preoperative NLR differed significantly in the FIGO stage between the low NLR group (NLR ≤3.8) and the high NLR group (NLR > 3.8), but no discrimination was observed in other parameters. The mean follow-up time was 45 months, and the post-operative 1- and 3-year survival rates were 93.7% and 60.0%, respectively. The preoperative NLR > 3.8 and stage Ⅲ/Ⅳ were all risk factors for poor overall and disease-free survival. Multivariate analysis revealed the patients with high NLR (P < 0.05) and stage Ⅲ/Ⅳ (P < 0.05) had prognostic significance for poor overall survival. The number of CD68-positive tumor-associated macrophages was significantly higher in the high NLR group than in the low NLR group (54.65 ± 8.78 and 41.78 ± 9.10, respectively; P < 0.001).   Conclusions   An elevated blood preoperative NLR indicates poor prognosis in patients with EOC. Preoperative NLR may function as an important independent prognostic factor for patients with EOC.