术前纤维蛋白原联合淋巴细胞与单核细胞比值对非小细胞肺癌患者预后的评估价值

Prognostic value of the combined preoperative plasma levels of fibrinogen and lymphocyte to monocyte ratio (F-LMR) in patients with non-small cell lung cancer

目的:探讨术前纤维蛋白原(fibrinogen,Fbg)联合淋巴细胞与单核细胞比值(lymphocyte to monocyte ratio,LMR)评分(FLMR)与非小细胞肺癌(non-small cell lung cancer,NSCLC)患者预后的相关性。方法:回顾性分析2006年1月至2009年12月天津医科大学肿瘤医院行根治性手术切除的589例NSCLC患者的临床病例资料。根据受试者工作特征(ROC)曲线判定Fbg及LMR的界限值,根据F-LMR评分原则将患者分为3组:F-LMR 0分、F-LMR 1分、F-LMR 2分。通过χ2检验分析其与患者临床病理因素的关系,Kaplan-Meier法进行生存分析,运用Log-rank法进行差异性检验,Cox比例风险模型进行单因素与多因素回归分析。结果:根据ROC曲线,3.48 g/L、3.23分别作为Fbg和LMR的界值。F-LMR 0分215例、F-LMR 1分228例、F-LMR 2分146例,术前F-LMR评分与年龄、性别、吸烟史、肿瘤位置、手术类型、病理分期、病理类型、肿瘤大小有显著相关(P<0.05)。单因素分析显示:肿瘤位置、手术类型、病理分期、肿瘤大小、F-LMR评分、LMR及Fbg水平是影响NSCLC患者预后的危险因素(P<0.05);多因素分析结果表明:病理分期(DFS:HR:1.700,95%CI:1.483~1.950,P<0.001;OS:HR:1.703,95%CI:1.486~1.952,P<0.001)和F-LMR评分(DFS:HR:1.264,95%CI:1.077~1.484,P=0.004;OS:HR:1.301,95%CI:1.107~1.528,P=0.001)是影响患者预后的独立危险因子。结论:术前F-LMR评分可作为预测行根治性切除的非小细胞肺癌患者预后的指标。

Objective： This study aims to evaluate the correlation of combined preoperative plasma levels of fibrinogen（Fbg） and lymphocyte to monocyte ratio（LMR）（F-LMR） with the prognosis of patients with non-small cell lung cancer（NSCLC） after complete resection. Methods： The clinical data of 589 patients with NSCLC who underwent complete resection in our hospital were retrospectively analyzed. Receiver operating characteristic curve（ROC） analysis was used to select the cut-off values of Fbg and LMR. Based on the criteria of F-LMR, we divided the patients into three groups： F-LMR 0 score, F-LMR 1 score, and F-LMR 2 score. The association between F-LMR and the clinicopathological characteristics was analyzed by the χ2test. Kaplan-Meier analysis was used to analyze the prognostic factors, and the log-rank test was used to determine the differences in survival rates. Prognostic factors were assessed by univariate and multivariate analyses（Cox＇s proportional hazards regression model）. Results： According to the ROC curve, the cut-off values of Fbg and LMR were 3.48 g/L and 3.23, respectively. F-LMR 0 score had n=215, F-LMR 1 score had n=228, and F-LMR 2 score had n=146. Preoperative F-LMR was closely related to age, gender, smoking history, tumor location, surgical type, pathological stage, pathological type, and tumor size（P0.05）. Univariate analysis showed that tumor location, surgical type, pathological stage, tumor size, F-LMR score, LMR, and Fbg were associated with survival（P0.05）. Multivariate analysis showed that the pathological stage [disease-free survival（DFS）： hazard ratio（HR） = 1.700, 95% confidence interval（CI） = 1.483-1.950, P0.001; overall survival（OS）： HR= 1.703, 95% CI=1.486-1.952, P0.001] and F-LMR score（DFS： HR= 1.264, 95% CI= 1.077-1.484, P=0.004; OS： HR= 1.301, 95% CI= 1.107-1.528, P=0.001）were the independent prognostic factors of NSCLC patients. Conclusion： The preoperative F-LMR score may be a useful blood marker for predicting the prognosis of patients with NSCLC with radical resection.