血常规参数对乳腺癌预后的判断价值

The value of peripheral blood parameters before treatment on disease-free survival of postoperative breast cancer patients

目的评价血常规中中性粒细胞与淋巴细胞绝对值的比值(NLR)以及血小板与淋巴细胞绝对值的比值(PLR)对根治术后乳腺癌预后的预测价值。方法回顾性分析术后无病生存(DFS)超过6个月的根治术后乳腺癌患者共273例(排除随访时间少于12个月且未复发的患者),计算术前每例患者的NLR及PLR,并结合术后病理及免疫组化激素受体、人表皮生长因子受体2(HER-2)表达情况,单因素分析评价各因素对DFS的影响,将其中有意义者纳入进行多因素Cox回归,筛选影响DFS的独立预后因素,Kaplan-Meier方法绘制术后DFS曲线并计算中位DFS,Log-rank法比较不同NLR和PLR时的DFS的差异。结果单因素及多因素分析表明,年龄、T分期、N分期、激素受体状态、HER-2状态、肿瘤分级、NLR是影响术后预后的独立因素(P<0.05)。治疗前NLR<6与NLR>6的患者,术后中位DFS分别是65个月(95%CI:49.7～80.2)和46个月(95%CI:40.6～51.4),术后5年DFS率分别为54.4%和33.2%(P=0.001)。单因素分析未发现治疗前PLR与术后生存之间有显著联系(P>0.05)。结论治疗前NLR水平是影响乳腺癌根治术后生存的独立预后因素。

Objective To evaluate the impact of nertrophil-lymphocyte ratio(NLR)and platelet-lymphocyte ratio(PLR)before treatment on disease free survival(DFS)in patients who underwent radical surgery for breast cancer.Methods A total of 273 patients who underwent surgery for breast cancer and had a DFS more than 6 months were enrolled in this retrospective study(the patients without relapse until the complete follow-up less than 12 months were excluded).NLR and PLR before treatment were calculated for each patient.Cox′s proportional hazard model was used to determine the most appropriate cutoff of NLR and PLR.The medical record of the patients was reviewed in detail and the characteristics of the patients and the findings of pathological examination were analyzed in order to find their potential association with DFS.Multivariate analysis using the Cox regression method was conducted in order to identify potential confounders that were significant in the univariate analysis.The Kaplan-Meier method was used to plot DFS curves.Results Univariate analysis and Cox regression analysis showed age at diagnosis,T stage,N stage,estrogen receptor status,HER-2 status,tumor grade and NLR before treatment were statistically significant associated with DFS of all the breast cancer patients in this study(P<0.05).Elevated NLR(>6)was found to be associated with poorer diagnosis.Median DFS of breast cancer patients with NLR<6 and NLR>6 was 65 months(95% CI,49.7-80.2 months)and 46 months(95% CI,40.6-51.4 months)respectively,and 5-year DFS rate of breast cancer patients with NLR<6 and NLR>6 was 54.4% and 33.2% respectively(P=0.001).Univariate analysis did not show significant association between any cutoff of PLR and DFS(P>0.05).Conclusions Pretreatment NLR is an independent prognostic factor for DFS for breast cancer patients after radical operation.