治疗前中性粒细胞-淋巴细胞比率与进展期非小细胞肺癌患者预后的相关性研究

Prognosis value of pretreatment netrophil-to-lymphocyte ratio in the advanced non-small cell lung cancer patients

目的探索中性粒细胞-淋巴细胞比率(NLR)作为进展期非小细胞肺癌(NSCLC)预后因素的价值及其与其他临床预后因素的相关性。方法回顾性分析2009年5月至2013年6月本院确诊的Ⅲb期及Ⅳ期NSCLC患者,根据入院前中性粒细胞-淋巴细胞比率(NLR)分为低NLR组(n=51)和高NLR组(n=35),分析潜在的预后因素如年龄、组织类型、性别、体力状态、转移部位数、化疗疗效及NLR。以Kaplan-Meier法计算患者的总生存期(OS)与无进展生存期(PFS)。结果全组患者的OS为449 d。高NLR组更多见于体力状态评分2(P=0.018)、低分化癌(P=0.020)、多处转移(P=0.003)及化疗疗效不佳(P=0.001)的患者。低NLR组和高NLR组中位PFS分别为227 d和128 d,中位OS分别为558和296 d,两组差异均有统计学意义(P<0.001)。多因素分析结果提示,体力状态和NLR是影响进展期NSCLC患者生存时间的独立预后因素。结论 NLR增高是进展期NSCLC的独立预后预测指标,NLR检测简易、可重复性高,可作为NSCLC患者的常规检测项目。

Objective To investigate neutrophil to lymphocyte ratio （NLR） as a prognostic factor and the correlation between NLR and other probable clinical prognostic factors in advanced non-small cell lung cancer （NSCLC） patients. Methods Stage Ⅲb and IV NSCLC patients diagnosed in Shanghai Chest Hospital from May 2009 to June 2013 were retrospectively reviewed. Patients were divided into low NLR group （n=51） and high NLR group （n=35） according to NLR levels assessed before admission. Potential prognostic factors such as age, histology, gender, performance status, number of metastatic site, response to chemotherapy and NLR were analyzed. Overall survival （OS） and progression free survival （PFS） were calculated by Kaplan-Meier method. Results Median OS for entire cohort was 449 days. Patients who had high NLR were seen more frequently in the performance status 2 （P=0.018）, poorly differentiated carcinoma （P=0.020）, multiple metastatic sites （P=0.003） and disease progression group （P=0.001）. Median PFS of patients with low NLR was 277 days, and in patients with high NLR was 128 days （P 〈 0.001）, and OS was 558 days versus 296 days for patients with low NLR and high NLR respectively （P 〈 0.001）. Conclusion Elevated NLR is a predictor of shorter survival in patients with advanced NSCLC. NLR is an easily measured, reproducible test that could be considered to be incorporated in the routine practice in NSCLC patients.