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值并确定最佳预测诊断截断值后分高低两组，Kaplan-Meier法绘制生存曲线，Cox比例风险回归模型分析预后因素。结果 以NLR=3.025、LMR=4.82和PLR=111.5为界，高NLR组患者的3、5年生存率分别为42.0%、28.0%，低NLR组分别为73.9%、60.2%（P=0.002），高LMR组分别为71.1%、55.3%（P<0.001），低LMR组分别为33.3%、10.4% ，高PLR组分别为30.8%、23.8%，低PLR组分别为63.6%、56.6%（P=0.001）。单因素分析显示NLR、PLR及LMR水平、肺转移均与患者死亡明显相关（P<0.05），多因素Cox回归分析显示NLR及LMR水平是影响患者总生存率的独立预后因素。结论 NLR、LMR水平是预测骨肉瘤患者预后的指标之一，NLR>3.025、LMR<4.82者生存期较短，可能需更积极化疗和密切随访改善临床治疗结果。

Relation Between NLR,LMR,PLR and Prognosis of Osteosarcoma

Objective To explore prognostic value of pre-treatment NLR,PLR and LMR in patients with osteosarcoma.Methods We retrospectively analyzed the clinical and survival data of 70 patients with osteosarcoma who received the same treatment regimen and calculated the NLR,PLR and LMR at initial diagnosis of osteosarcoma.ROC analysis was used to analyze the AUC and confirm the optimal cut-off value.Kaplan-Meier analysis was performed for survival curves.Cox regression models were employed to determine the independent prognostic factors.Results NLR=3.025,LMR=4.82 and PLR=111.5.The 3-and 5-year survival rates of patients with high NLR were 42.0%and 28.0%,while those in the low NLR group were 73.9%and 60.2%(P=0.002).The 3-and 5-year survival rates of patients in the high LMR group were 71.1%and 55.3%(P<0.001),while those in the low LMR group were 33.3%and 10.4%.The 3-and 5-year survival rates of patients with high PLR were 30.8%and 23.8%,while those in the low PLR group were 63.6%and 56.6%(P=0.001).Univariate analysis showed that NLR,PLR,LMR and lung metastasis were significantly correlated with patients’death(P<0.05).Multivariate Cox regression analysis showed that NLR and LMR were independent prognostic factors affecting the overall survival of osteosarcoma patients.Conclusion NLR and LMR levels are the prognostic indicators of patients with osteosarcoma.Patients with NLR>3.025 and LMR<4.82 have a short survival period,which may need more aggressive chemotherapy and close follow-up to improve clinical treatment results.