鼻咽癌同步放化疗前后炎性指标变化及预测价值

doi:10.6040/j.issn.1673-3770.0.2020.053

摘要/Abstract

摘要： 目的探讨局部晚期鼻咽癌同步放化疗前后外周血中性粒细胞与淋巴细胞比(NLR)和血小板与淋巴细胞比(PLR)的变化及对鼻咽癌复发的预测作用。方法回顾性分析初诊为局部晚期鼻咽癌并行同步放化疗229例患者病历资料,记录同步放化疗前后患者的中性粒细胞、血小板和淋巴细胞值,计算相应的NLR和PLR、ΔNLR和ΔPLR,使用受试者工作特征曲线(ROC),确定NLR和PLR、ΔNLR和ΔPLR的最佳临界值,并根据最佳临界值将ΔNLR和ΔPLR分别分为高低水平两组;使用Cox风险模型分析和Kaplan-Meier分析确定肿瘤复发的独立危险因素以及ΔNLR和ΔPLR对生存的影响。结果以肿瘤复发为结果,NLR和PLR、ΔNLR和ΔPLR的ROC曲线下面积(AUC)分别为0.680、0.678、0.854和0.730, 最佳临界值分别为2.730、135.550、4.982和122.553;单因素分析显示:T分期、N分期、临床分期、诱导/辅助化疗史NLR、PLR、ΔNLR、ΔPLR为鼻咽癌复发的相关因素,进一步行多因素分析提示T分期、N分期、ΔNLR、ΔPLR是鼻咽癌复发的独立危险因素;生存分析显示,ΔHNLR和ΔHPLR组的2年无复发生存率均低于ΔLNLR和ΔLPLR组(ΔHNLR vs. ΔLNLR=0.488 vs. 0.993;ΔHPLR vs. ΔLPLR=0.476 vs. 0.935),ΔHNLR和ΔHPLR组的中位无复发生存时间均为23个月。结论局部晚期鼻咽癌患者的NLR和PLR总体水平在同步放化疗后有所增加,治疗前后NLR和PLR差值越大肿瘤预后越差,且ΔNLR和ΔPLR可作为肿瘤复发的预测指标。

关键词: 鼻咽癌, 同步放化疗, 中性粒细胞与淋巴细胞比, 血小板与淋巴细胞比, 复发

Abstract: Objective To investigate the effect of the neutrophil-lymphocyte ratio(NLR)and platelet-lymphocyte ratio(PLR)in peripheral blood on the prognosis of nasopharyngeal carcinoma(NPC)before and after concurrent chemoradiotherapy. Methods Pre-/post-treatment and changes in neutrophil, platelet, and lymphocyte levels of 229 patients who were diagnosed with locally advanced NPC and received concurrent chemoradiotherapy in Renmin Hospital of Wuhan University were retrospectively analyzed. A receiver operating characteristic(ROC)analysis was performed to determine the optimal cutoff values of NLR, PLR, ΔNLR, and ΔPLR, and the patients were then divided into lower and higher groups according to the optimal cutoff values of ΔNLR and ΔPLR. A Kaplan-Meier analysis and Cox risk model were used to identify independent predictors of recurrence and prognosis. Results The areas under the ROC curve of PLR, NLR, ΔNLR, and ΔPLR in the diagnosis of tumor recurrence were 0.680, 0.678, 0.854, and 0.730, respectively, and the optimal cut-off values for each parameter were 2.730, 135.550, 4.982, and 122.553, respectively. Univariate analysis showed that TNM stages, clinical stages, PLR and NLR, ΔNLR, and ΔPLR were correlated with the recurrence of NPC, whereas the Cox regression model suggested that TNM stages, ΔNLR, and ΔPLR were independent risk factors for the recurrence of NPC. Kaplan-Meier analysis found that the 2-year recurrence-free survival rates of the ΔHNLR and ΔHPLR groups were lower than those of the ΔLNLR and ΔLPLR groups(ΔHNLR vs. ΔLNLR=0.488 vs. 0.993; ΔHPLR vs. ΔLPLR=0.476 vs. 0.935), and that the median recurrence-free survival time for both the ΔHNLR and ΔHPLR groups was 23 months. Conclusion Both NLR and PLR in patients with locally advanced NPC increased after concurrent chemoradiotherapy, and poorer prognosis was correlated with higher ΔNLR and ΔPLR values. Therefore, ΔNLR and ΔPLR can be used to assess risk for tumor recurrence in patients with locally advanced NPC.

Key words: Nasopharyngeal carcinoma, Concurrent chemoradiotherapy, Neutrophil-lymphocyte ratio, Platelet-lymphocyte ratio, Recurrence

中图分类号:

R739.6

范黎,黎越,徐细明. 鼻咽癌同步放化疗前后炎性指标变化及预测价值[J]. 山东大学耳鼻喉眼学报, 2020, 34(6): 36-41.

FAN Li, LI Yue, XU Ximing. Changes in and prognostic value of the inflammatory index before and after concurrent chemoradiotherapy for nasopharyngeal carcinoma[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(6): 36-41.

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