血小板与淋巴细胞比值对喉癌复发的预测价值

doi:10.6040/j.issn.1673-3770.1.2019.018

摘要/Abstract

摘要： 目的

探讨术前外周血血小板与淋巴细胞比值(PLR)、中性粒细胞与淋巴细胞比值（NLR）、衍生中性粒细胞与淋巴细胞比值（dNLR）对喉鳞状细胞癌患者复发的影响和预测价值。

方法

回顾性分析南京医科大学第一附属医院473例行初次手术治疗的喉鳞状细胞癌患者的临床资料。根据患者术前的PLR、NLR和dNLR，绘制诊断肿瘤复发的受试者工作特征曲线（ROC），确定PLR、NLR和dNLR界值，从而分成相应的低比值组和高比值组；并采用 Kaplan-Meier分析、COX风险模型分析PLR、NLR、dNLR以及其他临床病理参数与喉癌复发的关系。

结果

PLR、NLR和dNLR诊断肿瘤复发的ROC曲线下面积(AUC)分别为0.683、0.720和0.696。单因素分析显示: PLR、NLR、dNLR、分型、分期、病理分化程度、甲状软骨板累及、淋巴结转移、年龄、凝血功能与喉鳞状细胞癌患者的复发有关；COX风险模型显示: PLR、分型、年龄是影响喉鳞状细胞癌复发的独立危险因素。

结论

术前PLR高的喉鳞状细胞癌患者术后容易复发，PLR对复发的预测价值优于NLR和dNLR，可作为评估喉癌患者预后的重要指标。

关键词: 喉肿瘤，鳞状细胞, 血小板与淋巴细胞比值, 中性粒细胞与淋巴细胞比值, 复发, 预后

Abstract: Objective

To evaluate the impact of preoperative platelet-lymphocyte ratio (PLR), neutrophil-lymphocyte ratio (NLR) and derived NLR (dNLR) on the prognosis in patients with laryngeal squamous cell carcinoma.

Methods

The clinical data of 473 patients with laryngeal squamous cell carcinoma who underwent primary surgery in the First Affiliated Hospital of Nanjing Medical University were analyzed retrospectively. According to preoperative PLR, NLR and dNLR, the receiver operating characteristic curve (ROC) for diagnosing tumor recurrence was drawn to determine PLR, NLR and dNLR thresholds, and then the patients were divided into the lower groups and the higher groups. Kaplan-Meier analysis and COX risk model were used to analyze the relationship between PLR, NLR, dNLR, and other clinicopathological parameters and recurrence of laryngeal squamous cell carcinoma.

Results

The area under the ROC curve (AUC) of PLR, NLR and dNLR for the diagnosis of tumor recurrence were 0.683, 0.720 and 0.696, respectively. Univariate analysis showed that PLR, NLR, dNLR, tumor classification, TNM stages, pathological differentiation, invasion of thyroid cartilage plate, lymph nodes metastasis, age and coagulation were associated with recurrence in patients with laryngeal squamous cell carcinoma; In COX regression model, a higher PLR, tumor classification and age were identified as independent risk factors for the recurrence of laryngeal squamous cell carcinoma (P<0.001; P=0.033; P=0.030).

Conclusion

Laryngeal squamous cell carcinoma patients with high preoperative dNLR are more likely to relapse. Preoperative PLR is a more valuable prognostic factor than NLR and dNLR for recurrence of laryngeal squamous cell carcinoma. It could be a clinically biomarker for the prognosis of laryngeal squamous cell carcinoma.

Key words: Laryngeal neoplasms, squamous cell, Platelet-lymphocyte ratio, Neutrophil-lymphocyte ratio, Recurrence, Prognosis

中图分类号:

R767

陈慧君,宋圣花,周涵,董伟达,乔明哲,陈曦,徐进,林子萍,邢光前. 血小板与淋巴细胞比值对喉癌复发的预测价值[J]. 山东大学耳鼻喉眼学报, 2019, 33(3): 106-110.

Huijun CHEN,Shenghua SONG,Han ZHOU,Weida DONG,Mingzhe QIAO,Xi CHEN,Jin XU,Ziping LIN,Guangqian XING. Preoperative platelet-lymphocyte ratio is an independent prognostic factor for laryngeal squamous cell carcinoma[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(3): 106-110.

图/表 6

图1

图 2

图3

图4

表1

Kaplan-Meier生存分析：以喉癌复发为终点，研究不同组之间的差异"

变量

平均值（月）

CI（月）

3年生存率（%）

χ 2

dNLR

低

高

93.988

67.571

90.167~97.810

60.724~74.419

78.164

59.864

49.165

<0.001

NLR

低

高

96.185

72.316

92.107~100.262

66.675~77.958

78.039

64.762

43.232

<0.001

PLR

低

高

94.284

72.035

90.176~98.392

66.185~77.885

75.800

66.304

39.036

<0.001

分型

非声门型

声门型

67.656

90.374

59.090~76.222

86.639~94.109

54.286

75.543

28.447

<0.001

分期

I+II

III+IV

90.823

70.084

87.098~94.549

62.052~78.116

77.778

52.672

26.108

<0.001

病理分化

低分化

中+高分化

64.908

87.606

52.291~77.525

83.940~91.272

47.541

74.272

14.723

<0.001

甲状软骨板累及

无

有

86.757

65.196

83.144~90.371

48.735~81.656

72.789

43.750

11.992

0.001

淋巴结转移

无

有

88.984

61.431

85.359~92.609

50.596~72.266

74.631

47.761

28.793

<0.001

年龄

＜60岁

≥60岁

90.846

81.306

85.451~96.242

76.620~85.991

77.325

67.110

6.256

0.012

凝血功能

正常

异常

88.411

74.446

84.610~92.212

65.512~83.379

77.839

51.430

11.685

0.001

表1

表 2

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变量	HR	HR（CI）	B	P
分型	0.640	0.424~0.964	-0.447	0.033
PLR	2.011	1.378~2.936	0.699	＜0.001
年龄	1.537	1.043~2.265	0.430	0.030