术前外周血中性粒细胞与淋巴细胞比值在评估食管腺癌患者预后中的价值

Prognostic value of neutrophil-to-lymphocyte ratio in patients with esophageal adenocarcinoma

目的探讨术前外周血中性粒细胞与淋巴细胞比值（NLR）在食管腺癌患者预后评估中的影响。方法收集114例食管腺癌患者的临床和随访资料，根据患者术前1周内血常规结果，计算术前外周血NLR。分析术前外周血NLR与其他临床病理特征的相关性，利用Kaplan-Meier法计算生存率，Log-rank检验比较不同组间的差异。采用Cox回归分析对可能影响患者预后的因素进行分析。结果单因素分析结果显示食管腺癌患者的预后与肿瘤大小、淋巴结转移、病理分期、住院时间和NLR水平相关（P＝0.000、0.000、0.000、0.038、0.000）。高NLR组和低NLR组术后1、3、5年生存率分别为81.3%、22.9%、3.1%和92.4%、69.7%和31.2%（P＝0.088、0.000、0.000）；Cox回归分析结果显示，除病理分期外[风险比（HR）＝4.450，95%可信区间（CI）：2.990～6.623，P＝0.000]，术前外周血NLR也是影响术后总体生存的独立预后因素（HR＝2.739，95%CI：1.687～4.446，P＝0.000）。根据患者肿瘤位置分层分析的结果显示，病理分期和NLR水平是影响中上段和下段食管腺癌患者预后的独立因素（HR＝6.983，95%CI：3.311～14.729，P＝0.000；HR＝2.319，95%CI：1.015～5.299，P＝0.046；HR＝4.241，95%CI：2.557～7.035，P＝0.000；HR＝3.192，95%CI：1.726～5.903，P＝0.000）。结论术前外周血NLR能较好地评估食管腺癌患者的手术风险。

ObjectiveTo investigate the prognostic value of neutrophil-to-lymphocyte ratio （NLR） in patients with esophageal adenocarcinoma.MethodsWe retrospectively analyzed 114 patients with esophageal adenocarcinoma treated in our hospital. The NLR was calculated with the following formula： peripheral neutrophil count/lymphocyte count （×109/L）. Correlations of NLR with other clinicopathological data and prognosis were analyzed. The survival was calculated by Kaplan-Meier analysis. The differences between groups were compared using Log-rank test. Cox regression was used to analyze the factors which may affect the survival of the patients.ResultsThe survival rate was found to be related to tumor size, N stage, TNM stage, hospital stay time and NLR （P=0.000, 0.000, 0.000, 0.038, 0.000）. High NLR group had significantly poorer survival than low NLR group （1-, 3-, 5-year survival rate： 81.3% vs. 92.4%, 22.9% vs. 69.7%, 3.1% vs. 31.2%, P=0.000）. Besides TNM stage [hazard ratio （HR）=4.450, 95% confidence interval （CI）： 2.990-6.623, P=0.000], NLR was identified as an independent prognostic factor for patients with esophageal adenocarcinoma （HR=2.739, 95%CI： 1.687-4.446, P=0.000）. According to the sub-site stratified analysis, TNM stage and NLR were independent risk factors for both upper/middle section group and lower section group （HR=6.983, 95%CI： 3.311-14.729, P=0.000; HR=2.319, 95%CI： 1.015-5.299, P=0.046; HR=4.241, 95%CI： 2.557-7.035, P=0.000; HR=3.192, 95%CI： 1.726-5.903, P=0.000）.ConclusionNLR is a valuable clinical marker in preoperative estimation as well as prognosis prediction for patients with esophageal adenocarcinoma.