术前中性粒细胞与淋巴细胞比值联合纤维蛋白原与乳腺癌患者预后的关系

Relationship of preoperative neutrophil to lymphocyte ratio and fibrinogen with the prognosis of breast cancer patients

目的探讨术前中性粒细胞与淋巴细胞比值(NLR)联合纤维蛋白原(FIB)(FIB-NLR)与乳腺癌患者预后的关系。方法回顾性分析104例乳腺癌患者的临床资料,包括年龄、肿瘤大小、临床分期、淋巴结转移情况、NLR、FIB水平、雌激素受体(ER)、孕激素受体(PR)和人类表皮生长因子受体2(HER2)的表达情况及患者的生存情况等。根据FIB-NLR进行分组,FIB≤4 g/L且NLR≤3.5的患者为FIB-NLR 0分组(n=44),FIB﹥4 g/L或NLR﹥3.5的患者为FIB-NLR 1分组(n=36),FIB﹥4 g/L且NLR﹥3.5的患者为FIB-NLR 2分组(n=24),比较不同组别乳腺癌患者的生存情况。比较不同临床特征乳腺癌患者的生存率,分析影响乳腺癌患者预后的因素。结果FIB-NLR 0分组患者的1、3、5年生存率分别为97.73%(43/44)、95.45%(42/44)和90.91%(40/44);FIB-NLR 1分组患者的1、3、5年生存率分别为97.22%(35/36)、94.44%(34/36)和83.33%(30/36);FIB-NLR 2分组患者的1、3、5年生存率分别为83.33%(20/24)、70.83%(17/24)和66.67%(16/24)。FIB-NLR 2分组患者的5年生存率明显低于FIB-NLR 1分组和FIB-NLR 0分组,差异均有统计学意义(P﹤0.01)。单因素分析结果显示,不同临床分期、淋巴结转移情况、FIB水平、NLR及FIB-NLR评分的乳腺癌患者的5年生存率比较,差异均有统计学意义(P﹤0.05);多因素分析结果显示,临床分期为Ⅲ期、有淋巴结转移、FIB﹥4 g/L、NLR﹥3.5及FIB-NLR为2分均是乳腺癌患者预后的独立危险因素(P﹤0.05)。结论临床分期为Ⅲ期、有淋巴结转移、FIB﹥4 g/L、NLR﹥3.5及FIBNLR为2分均是乳腺癌患者预后的独立危险因素,FIB-NLR可作为临床上乳腺癌患者术前的必要检测指标之一。

Objective To investigate the relationship of preoperative neutxophil to lymphocyte ratio （NLR） and fibrinogen （FIB） with the prognosis of breast cancer patients. Method The clinical and follow-up data of 104 patients with breast cancer were analyzed retrospectively, including age, the size of tumor, clinical stage, lymph node metastasis, the NLR value, FIB level, the expression of estrogen receptor （ER）, progesterone receptor （PR） and human epidermal growth factor receptor 2 （HER2）, and survival of the patient. Patients were divided into FIB-NLR 0 score group （FIB≤4 g/ L and NLR≤3.5）, FIB-NLR 1 score group （FIB〉4 g/L or NLR〉3.5） and FIB-NLR 2 score group （FIB〉4 g/L and NLR〉 3.5） according to FIB-NLR level, and the survival rates among groups were compared. The survival rates among patients with different clinical characteristics were compared and the prognostic factors of breast cancer patients were analyzed. Result During the 1^st, 3^rd, and 5^th follow-up year, the survival rates of FIB-NLR 0 score group were 97.73% （43/44）, 95.45% （42/44） and 90.91% （40/44）, respectively; the survival rates of FIB-NLR 1 score group were 97.22% （35/36）, 94.44% （34/36） and 83.33% （30/36）, respectively; and the survival rates of patients in FIB-NLR 2 score group were 83.33% （20/24）, 70.83% （17/24） and 66.67% （16/24）. The 5 year survival rate of breast cancer patients in FIB-NLR 2 score group was significantly lower than those of patients in FIB-NLR 0 and 1 score groups （P〈0.01）. Univariate analysis showed that the 5 year survival rates of breast cancer patients with different clinical staging, with or without lymph node metastasis, with different level of FIB and NLR and with different FIB-NLR score, were all significantly different （P〈 0.05）. Multivariate analysis showed that clinical stage III, lymph node metastasis, FIB〉4 g/L, NLR〉3.5 and FIB-NLR 2 score were all independent risk factors of prognosis of breast cancer patients （P〈0.05）. Conclusion The clinical stage III, lymph node metastasis, FIB〉4 g/L, NLR〉3.5 and FIB-NLR 2 score were all independent risk factors of prognosis of breast cancer patients, and FIB-NLR worth to be used as one of the necessary preoperative detection indexes for breast cancer patients.