血小板淋巴细胞比和中性粒细胞淋巴细胞比对前列腺癌内分泌治疗后早期去势抵抗预测价值的研究

The prognostic value of platelet to lymphocyte ratio and neutrophil to lymphocyte ratio in the patients with early castration resistant prostate cancer after androgen deprivation therapy

目的 研究血小板淋巴细胞比（platelet to lymphocyte ratio,PLR）和中性粒细胞淋巴细胞比（neutrophil to lymphocyte ratio,NLR）与前列腺癌内分泌治疗后出现早期去势抵抗之间的关系.方法 回顾性分析2009年1月至2013年12月我们收治的305例前列腺癌患者的临床资料.年龄50 ～91岁,平均75.3岁.PSA 1.09～285.00 ng/ml,平均64.05ng/ml.肿瘤分期Ⅱ期124例,Ⅲ期138例,Ⅳ期43例.144例有骨转移,161例无骨转移.Gleason评分≥8分者138例,＜8分者167例.改良格拉斯哥评分（modified Glasgow prognostic score,mGPS）0分237例,1分29例,3分39例.根据检测的PLR及NLR,将患者分为高PLR组、低PLR组、高NLR组和低NLR组,比较不同PLR、NLR组间前列腺癌各项临床指标之间的差异,分析前列腺癌早期去势抵抗的危险因素并评估其诊断价值.结果 通过受试者工作特征（receiver operating characteristic,ROC）曲线计算得出PLR、NLR的最佳截点值分别为115.0和2.3.PLR与患者的肿瘤分期、Gleason评分及mGPS等相关,NLR与患者的肿瘤分期、是否骨转移、Gleason评分及mGPS等相关（P＜0.05）.高PLR组和高NLR组无去势抵抗的生存时间分别低于低PLR组[（23.8±1.5）个月与（56.1±2.5）个月,P＜0.05]和低NLR组[（29.1±2.1）个月与（49.8±2.5）个月,P＜0.05].Cox单因素及多因素分析表明PLR≥115.0、NLR≥2.3、Gleason评分≥8分及mGPS=2分是前列腺癌患者发生早期去势抵抗的独立危险因素（均P＜0.05）.PLR的ROC曲线下面积为0.711,诊断价值较好;NLR的曲线下面积为0.648,也具有一定的诊断价值.结论 PLR及NLR可作为辅助指标判断前列腺癌患者经内分泌治疗的预后情况,可作为前列腺癌患者发生早期去势抵抗的独立危险因素,且PLR对于前列腺癌早期去势抵抗的诊断预测价值高于前列腺癌其他各项肿瘤临床指标.

Objective To analyze and evaluate the association between platelet to lymphocyte ratio （PLR）,neutrophil to lymphocyte ratio （NLR） and early castration-resistant prostate cancer （CRPC） patients after androgen deprivation therapy.Methods Clinical data of 305 patients with prostate cancer between January 2009 and December 2013 were retrospectively analyzed.All the patients underwent prostate biopsy and were diagnosed by pathological examination.Based on the PLR and NLR,the patients were assigned into high PLR group,low PLR group,high NLR group,and low NLR group.Clinical features including tPSA,mGPS,clinical stage,Gleason score and castration methods were compared with PLR and NLR.Kaplan-Meier method was used to compare the differences of castration resistant progression free survival between different PLR and NLR groups.Univariate and multivariate Cox regression models were used to analyze the prognostic value of PLR,NLR,and other clinical features for early castration resistance.Results The values of NLR and PLR were calculated by ROC curve,and the best cut-off values were 115.0 and 2.3.PLR was related with the tumor stage,Gleason score and mGPS.NLR was related with the tumor stage,bone metastasis,Gleason score and mGPS（P 〈 0.05）.PLR and NLR were all risk factors of poor progression-free survival （P 〈 0.05）.PLR =115,NLR =2.3,Gleason =8 score and mGPS =2 score were independent risk factors of prostate cancer patients in early progression to castration resistance （P 〈 0.05）.The area under the ROC curve of PLR was 0.711,and the diagnostic value was the best.The area under the curve of NLR was 0.648,and it had a certain diagnostic value.Conclusions PLR and NLR can be used as a marker of prognosis after endocrine therapy in patients with prostate cancer,and can be used as independent risk factors for castration resistant progression of prostate cancer patients.And the prognostic value of PLR for early castration resistance is higher than other tumors clinical indicators.