NLR、PLR和LMR对脑转移瘤患者全脑放疗预后的影响及相关因素分析

  目的  探讨放疗前外周血中性粒细胞-淋巴细胞比值（NLR）、血小板-淋巴细胞比值（PLR）及淋巴细胞-单核细胞比值（LMR）对脑转移患者全脑放疗预后的影响。  方法  回顾性纳入118例脑转移患者的临床资料，分析各个炎性复合指标和临床资料与脑转移瘤患者全脑放疗预后的关系。采用ROC曲线确定脑转移瘤患者全脑放疗预后NLR、PLR及LMR的临界值。采用Kaplan-Meier法进行单因素生存分析、Log-rank检验进行各组生存率之间的比较，采用Cox比例风险模型进行多因素回归分析。  结果  118例脑转移瘤患者的中位生存期为12.5月，1年、2年生存率分别为72.8%和50.1%。通过ROC曲线确定NLR、PLR和LMR的临界值分别为4.28、217.8和1.95。Kaplan-Meier单因素分析显示，肿瘤分期、靶向治疗、NLR、PLR以及LMR均是影响脑转移瘤患者全脑放疗预后的危险因素（P=0.001、0.032、0.008、0.003、0.002），进一步多因素Cox回归分析表明PLR是唯一的独立不良预后因素（P=0.003）。  结论  放疗前外周血PLR升高是脑转移瘤患者全脑放疗的独立不良预后因素。 

Effect of pre-radiotherapy NLR,PLR and LMR on the prognosis of patients with brain metastases and analysis of related factors

  Objective  To investigate the relationship between peripheral blood neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and lymphocyte to monocyte ratio (LMR) and prognosis of patients with brain metastases.  Methods  A total of 118 patients with brain metastases treated with whole brain radiotherapy were retrospectively analyzed. The relationship of NLR, PLR, LMR and clinical data with the prognosis patients were analyzed. Receiver operating characteristic curve was used to calculate the optimal cut-off values of NLR, PLR and LMR. The overall survival analysis was performed by Kaplan- Meier method. Significant differences were analyzed by Log-rank test. Multivariate analysis for survival was performed by Cox proportional regression model.  Results  The median overall survival time of 188 patients with brain metastases was 12.5 months. The 1-year, 2-year survival rates were 72.8% and 50.1%, respectively. The optimal cut-off values of NLR, PLR and LMR were determined by ROC curve to be 4.28, 217.8 and 1.95, respectively. The tumor stage, targeted therapy, NLR, PLR, and LMR were all associated with the prognosis of patients with brain metastases (P=0.001, 0.032, 0.008, 0.003, 0.002). The PLR were an independent prognostic factors for the patients with brain metastases (P=0.003).  Conclusion  The peripheral blood PLR before whole brain radiotherapy may be an independent prognostic factor in the patients with brain metastases.