中性粒细胞与淋巴细胞比值对T3N0M0期食管鳞癌术后辅助治疗预后的预测价值

目的:评估术前中性粒细胞/淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)与T3N0M0期食管鳞癌患者临床病理指标及预后的相关性,探索其对术后辅助治疗的预测价值。方法:回顾性分析2008~2014年行根治性手术的317例食管鳞癌患者的临床病理资料,以NLR的中位数2.14作为截点,分为高NLR组(NLR≥2.14)和低NLR组(NLR<2.14);高NLR组159例,低NLR组158例。分析NLR与临床病理、预后相关性及对术后辅助治疗的指导作用。结果:不同NLR分组患者的远期生少质量评估、肿瘤位置,以及肿瘤分期存在差异,差异有统计学意义(P<0.05)。多因素Cox回归分析的结果表明,高NLR组患者发生死亡的风险是低NLR组患者的1.43倍(HR:1.43,95%CI:1.01~2.02,P=0.041)。Kaplan-Meier分析表明,不同NLR分组患者的5年总生存率存在差异,差异有统计学意义(P=0.006),高NLR组患者的5年总生存率低于低NLR组(50%vs 70%);不同NLR分组患者的无进展生存率存在差异,差异有统计学意义(P=0.017),高NLR组患者的无进展生存率低于低NLR组(45%vs 60%)。在低NLR值组中,术后辅助治疗与单纯手术治疗患者的5年总生存率存在差异(P<0.001),术后辅助治疗患者的5年总生存率高于单纯手术治疗(75%vs 45%);术后辅助治疗与单纯手术治疗患者的无进展生存率存在差异(P<0.001),术后辅助治疗患者的无进展生存率高于单纯手术治疗(78%vs 40%)。在高NLR值组中,术后辅助治疗与单纯手术患者的5年总生存率和无进展生存率差异无统计学意义。结论:NLR与T3N0M0期食管鳞癌临床病理指标具有相关性,对术后辅助治疗也提供了指导作用。

Neutrophil-to-Lymphocyte Ratio in the Prediction of Outcomes of Postoperative Adjuvant Therapy in Esophageal Squamous Cell Carcinoma Staged T3M0N0

Objective:To evaluate the relation of neutrophil-to-lymphocyte ratio(NLR)to clinicopathological parameters and prognosis of esophageal squamous cell carcinoma(ESCC)staged T3M0N0,and the value of NLR for postoperative adjuvant therapy in ESCC staged T3N0M0.Methods:Clinicopathological data of 317 ESCC patients who underwent esophagectomy from 2008 to 2014 were retrospectively analyzed.The patients were assigned to the high NLR group(NLR≥2.14,159 cases)and the low NLR group(NLR≥2.14,158 cases)with the median value of NLR(2.14)as the cut-off point.We analyzed the relation of NLR to clinicopathological parameters and prognosis of patients,and the effect of NLR in guiding postoperative adjuvant therapy.Results:NLR was significantly correlated with Karnofsky score,tumor location and pathological stage(P<0.05).Multivariate Cox regression analysis showed that the risk of death in the high NLR group was 1.43 times that of the risk of death in the low NLR group(HR:1.43,95%CI:1.01-2.02,P=0.041).Kaplan-Meier analysis showed that the 5-year overall survival rates in different NLR groups were significantly different(P=0.006).The 5-year overall survival rate in the high NLR group was lower than that in the low NLR group(50%vs 70%).The progression-free survival rates in different NLR groups were significantly different(P=0.017).The progression-free survival rate in the high NLR group was lower than that in the low NLR group(45%vs 60%).In the low NLR group,the 5-year overall survival rate of patients undergoing surgery plus postoperative adjuvant therapy was higher than that of patinets undergoing surgery only(75%vs 45%,P<0.001).The progression-free survival rate of the former was also higher than that of the latter(78%vs 40%,P<0.001).In the high NLR group,there were no statistically significant differences in 5-year overall survival rate and the progression-free survival rate of patients with different treatment strategies.Conclusion:NLR,which is correlated with clinicopathological indexes of ESCC staged T3N0M0,also provides guidance for postoperative adjuvant treatment。