血小板与淋巴细胞比值对喉癌复发的预测价值

Preoperative platelet-lymphocyte ratio is an independent prognostic factor for laryngeal squamous cell carcinoma

目的探讨术前外周血血小板与淋巴细胞比值(PLR)、中性粒细胞与淋巴细胞比值(NLR)、衍生中性粒细胞与淋巴细胞比值(dNLR)对喉鳞状细胞癌患者复发的影响和预测价值。方法回顾性分析南京医科大学第一附属医院473例行初次手术治疗的喉鳞状细胞癌患者的临床资料。根据患者术前的PLR、NLR和dNLR,绘制诊断肿瘤复发的受试者工作特征曲线(ROC),确定PLR、NLR和dNLR界值,从而分成相应的低比值组和高比值组;并采用Kaplan-Meier分析、COX风险模型分析PLR、NLR、dNLR以及其他临床病理参数与喉癌复发的关系。结果PLR、NLR和dNLR诊断肿瘤复发的ROC曲线下面积(AUC)分别为0.683、0.720和0.696。单因素分析显示:PLR、NLR、dNLR、分型、分期、病理分化程度、甲状软骨板累及、淋巴结转移、年龄、凝血功能与喉鳞状细胞癌患者的复发有关;COX风险模型显示:PLR、分型、年龄是影响喉鳞状细胞癌复发的独立危险因素。结论术前PLR高的喉鳞状细胞癌患者术后容易复发,PLR对复发的预测价值优于NLR和dNLR,可作为评估喉癌患者预后的重要指标。

Objective To evaluate the impact of preoperative platelet-lymphocyte ratio(PLR),neutrophil-lymphocyte ratio(NLR)and derived NLR(dNLR)on the prognosis in patients with laryngeal squamous cell carcinoma. Methods The clinical data of473 patients with laryngeal squamous cell carcinoma who underwent primary surgery in the First Affiliated Hospital of Nanjing Medical University were analyzed retrospectively. According to preoperative PLR,NLR and dNLR,the receiver operating characteristic curve(ROC)for diagnosing tumor recurrence was drawn to determine PLR,NLR and dNLR thresholds,and then the patients were divided into the lower groups and the higher groups. Kaplan-Meier analysis and COX risk model were used to analyze the relationship between PLR,NLR,dNLR,and other clinicopathological parameters and recurrence of laryngeal squamous cell carcinoma. Results The area under the ROC curve(AUC)of PLR,NLR and dNLR for the diagnosis of tumor recurrence were0.683,0.720 and0.696,respectively. Univariate analysis showed that PLR,NLR,dNLR,tumor classification,TNM stages,pathological differentiation,invasion of thyroid cartilage plate,lymph nodes metastasis,age and coagulation were associated with recurrence in patients with laryngeal squamous cell carcinoma;In COX regression model,a higher PLR,tumor classification and age were identified as independent risk factors for the recurrence of laryngeal squamous cell carcinoma(P<0.001;P=0.033;P=0.030).Conclusion Laryngeal squamous cell carcinoma patients with high preoperative dNLR are more likely to relapse. Preoperative PLR is a more valuable prognostic factor than NLR and dNLR for recurrence of laryngeal squamous cell carcinoma. It could be a clinically biomarker for the prognosis of laryngeal squamous cell carcinoma.