术前单核细胞淋巴细胞比值对食管胃结合部癌患者术后生存的影响

Effect of preoperative monocyte-lymphocyte ratio on prognosis of patients with reseetable esophagogastric junction cancer

目的评价单核细胞淋巴细胞比值（MLR）对食管胃结合部癌手术患者预后评估的价值，并将MLR和中性粒细胞淋巴细胞比值（NLR）以及血小板淋巴细胞比值（PLR）与患者预后的关系进行比较。方法回顾性分析309例经根治性手术治疗的食管胃结合部癌患者的临床资料，分析MLR、NLR和PLR与患者预后的关系。结果MLR、NLR和PLR判断食管胃结合部癌患者总生存时间的最佳截点值分别为0.201、1.697和96.960。全组309例患者的中位生存时间为51.4个月。食管胃结合部癌患者的MLR与患者的性别、浸润深度、病理分级、TNM分期、NLR和PLR有关（均P〈0.05），PLR与患者的肿瘤大小、TNM分期、NLR和MLR有关（均P〈0.05），NLR与患者的性别、肿瘤大小、TNM分期、PLR和MLR有关（均P〈0.05）。单因素分析结果显示，肿瘤大小、浸润深度、转移淋巴结数目、病理分级、是否神经浸润、是否有脉管癌栓、TNM分期、PLR和MLR与患者的中位生存时间有关（均P〈0.05）。多因素分析表明，TNM分期、神经浸润和MLR是影响食管胃结合部癌手术患者预后的独立因素（均P〈0.05）；而PLR和NLR并非独立的预后因素（均P〉0.05）。MLR的最佳截点值设为0.201时，得到的曲线下面积为0.603，明显高于PLR和NLR（均P〈0.05）。结论术前MLR是食管胃结合部癌手术患者非常有用的预测因子。术前MLR〉0.201是食管胃结合部癌患者术后生存不良的因素，但若患者的PLR〉96.960亦应考虑有预后不良的风险。

Objective To investigate the associations between various blood test parameters including MLR （monocyte-lymphocyte ratio） and prognosis in post-operative esophagogastric junction cancer patients. Methods We retrospectively studied the preoperative and postoperative data of 309 patients who underwent radical surgery for esophagogastric junction cancer. The relationship between MLR, neutrophil lymphocyte ratio （NLR）, platelet-lymphocyte ratio （PLR） and overall survival （OS） was analyzed. Results The cutoff values of MLR,NLR and PLR were 0.201, 1.697 and 96.960, respectively. The median OS was 51.4 months for all the patients in the study group （n= 309）. MLR in patients with esophagogastric junction carcinoma was associated with gender, depth of invasion, histological grade, TNM stage, NLR and PLR （P〈0.05）. PLR was associated with tumor size, TNM stage, NLR and MLR （P〈 0.05）. NLR was associated with gender, tumor size, TNM stage, PLR and MLR （both P〈0.05）. Univariate analysis showed that tumor size, depth of tumor invasion, metastasis of lymph nodes, pathological grading, nerve infiltration, lymphovascular invasion, TNM staging, PLR and MLR were associated with the median overall survival time （P〈 0.05 ）. Muhivariate analysis showed that TNM stage, nerve infiltration and MLR were independent prognostic predictors for patients with esophagogastric junction cancer （P〈0.05）, but not PLR or NLR. Setting the optimal cut-off value of the MLR in 0.201, the area under the curve was 0.603, significantly larger than that of PLR and NLR （P〈0.05）. Conclusions Preoperative MLR is a very useful predictor of patients with esophagogastric junction cancer who underwent radical rescetion. Preoperative MLR〉 0.201 is an independent risk factor for postoperative survival in patients with esophagogastric cancer, and PLR 〉96.960 may predict a poor prognosis risk.