中性粒细胞与淋巴细胞比值对宫颈癌患者同步放化疗疗效及预后判断的临床意义

The ratio of neutrophil to lymphocyte in the efficacy and prognosis of concurrent chemoradiotherapy in patients with cervical cancer and its clinical significance

目的探讨宫颈癌患者治疗前中性粒细胞与淋巴细胞比值(Neutrophils to lymphocytes ratio,NLR)与预后的关系。方法选取247例哈尔滨医科大学附属肿瘤医院收治的接受同步放化疗的宫颈癌患者(IB-ⅢB期),回顾性分析临床病理资料和随访记录。绘制ROC曲线评价患者接受治疗前NLR对患者预后的预测效果;分析患者临床病理资料与NLR水平的关系;应用Kaplan-Meier法绘制生存曲线,建立Cox比例风险模型分析患者预后影响因素。结果 ROC曲线结果显示治疗前NLR对宫颈癌患者的预后有较好的诊断价值(AUC=0. 591,P=0. 014),NLR最佳分界值为2. 08,是总生存期(OS)和无进展生存期(PFS)的影响因素(HR=2. 469,P <0. 001; HR=2. 663,P <0. 001);按照高低NLR分组,发现在宫颈癌患者中NLR水平与临床分期、分化程度和组织学类型等有关(P <0. 05);高NLR组OS和PFS显著低于低NLR组(P <0. 001),其中PF方案化疗患者治疗前NLR水平对预后具有很好的提示作用。结论治疗前NLR水平可作为宫颈癌患者(尤其是PF化疗方案)的预后风险评价指标。

Objective The aim of the study was to investigate the relationship between the pre-treatment neutrophil to lymphocyte ratio（NLR）and prognosis in patients with cervical cancer.Methods A total of 247 patients with cervical cancer who received concurrent chemoradiotherapy（ⅠB-ⅢB stage）admitted to the Affiliated Tumor Hospital of Harbin Medical University were enrolled.The clinical pathological data and follow-up records were retrospectively analyzed.The receiver operating characteristic（ROC）curve was used to evaluate the predictive effect of NLR on the prognosis of patients before treatment.The relationship between clinicopathological data and NLR level was also analyzed.The Kaplan-Meier survival analysis and Cox regression analysis were used to assess the prognosis of patients.The survival curve was drawn by Kaplan-Meier method,and the Cox proportional hazard model was established to analyze the prognostic factors.Results The Results of ROC curve showed that NLR had a good diagnostic value for the prognosis of patients with cervical cancer（AUC=0.591,P=0.014）,the optimal cut-off value of NLR was 2.08,and the hazard ratio（HR）for overall survival（OS）and patients with high no progression in NLR Survival（PFS）was 2.469 and 2.663,respectively（P〈0.001）;According to the high and low NLR group,levels of NLR were found to be significantly associated with survival,treatment regimen,clinical stage,and histological type in cervical cancer patients;OS and PFS time were significantly lower than that in the low NLR group（P〈0.001）,and the pre-treatment NLR level in patients with PF regimen had a good prognosis for prognosis.Conclusion The levels of pre-treatment can be used as a prognostic risk assessment index for cervical cancer patients（especially PF chemotherapy）.