局部晚期子宫颈癌患者外周血淋巴细胞与单核细胞比值的预后价值

Prognostic value of lymphocyte-to-monocyte ratio in peripheral blood of patients with locally advanced cervical cancer

目的探讨治疗前外周血淋巴细胞与单核细胞比值(LMR)在局部晚期子宫颈癌患者预后评估中的意义.方法回顾性分析2012年7月至2016年2月徐州医科大学附属医院收治的128例ⅡB~ⅣA期子宫颈癌患者的临床和随访资料.根据外周血LMR的最佳临界值将患者分为高LMR组(>5.19,58例)和低LMR组(≤5.19,70例),对比分析两组临床特征和无进展生存(PFS)期,并探讨影响局部晚期子宫颈癌患者预后的因素.结果两组患者淋巴细胞计数(t=5.211,P<0.01)、单核细胞计数(t=6.282,P<0.01)、淋巴结转移(χ^2=9.436,P=0.002)、肿瘤分期(χ^2=6.624,P=0.010)、鳞状细胞癌相关抗原(SCCA)水平(Z=2.515,P=0.012)、癌胚抗原(CEA)水平(Z=3.232,P=0.001)、糖类抗原199(CA199)水平(Z=2.319,P=0.020)比较,差异均具有统计学意义;而年龄(t=0.291,P=0.771)、病理类型(χ^2=0.003,P=0.957)、治疗方式(χ^2=0.728,P=0.394)、CA125水平(Z=0.089,P=0.929)、CA153水平(Z=0.859,P=0.390)比较,差异均无统计学意义.高LMR组患者近期总有效为82.8%(48/58),高于低LMR组患者的61.4%(43/70),差异有统计学意义(P=0.008).高LMR组中位PFS时间(36个月)长于低LMR组(19个月)(HR=0.1295,95%CI 0.081~0.206,P<0.01).在鳞状细胞癌和腺癌、临床分期ⅡB期和ⅢA~ⅣA期患者中,高LMR组中位PFS时间分别为36、31、36、36个月,均长于低LMR组的20、15、20、18个月,差异均具有统计学意义(均P<0.05).单因素分析显示,单核细胞>0.37×109/L、LMR≤5.19、SCCA>15.24 U/ml与患者不良预后相关(均P<0.05).多因素分析显示LMR≤5.19是影响患者预后的独立危险因素(HR=2.006,95%CI 1.017~3.957,P=0.045).结论治疗前外周血LMR可以反映局部晚期子宫颈癌患者生存预后,低LMR提示预后不良.

Objective To investigate the significance of lymphocyte-to-monocyte ratio (LMR) in peripheral blood before the treatment in prognosis evaluation of patients with locally advanced cervical cancer. Methods The clinical and follow-up data of 128 patients with cervical cancer in stage Ⅱ B-Ⅳ A from July 2012 to February 2016 in the Affiliated Hospital of Xuzhou Medical University were retrospectively analyzed. The patients were divided into the high LMR group (>5.19, 58 cases) and the low LMR group (≤5.19, 70 cases) according to the optimal cutoff value of peripheral blood LMR. And the clinical characteristics and progression-free survival (PFS) time of the two groups were compared and analyzed. At the same time, the factors affecting the prognosis of patients with locally advanced cervical cancer were also discussed. Results The lymphocyte count (t = 5.211, P < 0.01), monocyte count (t = 6.282, P < 0.01), lymph node metastasis (χ 2 = 9.436, P = 0.002), tumor stage (χ 2 = 6.624, P = 0.010), squamous cell carcinoma antigen (SCCA) level (Z = 2.515, P = 0.012), carcinoembryonic antigen (CEA) level (Z = 3.232, P = 0.001), carbohydrate antigen199 (CA199) level (Z = 2.319, P = 0.020) of two groups had statistically significant differences. In addition, age (t = 0.291, P = 0.771), pathological type (χ 2 = 0.003, P = 0.957), treatment method (χ 2 = 0.728, P =0.394), CA125 level (Z = 0.089, P = 0.929), CA153 level (Z = 0.859, P = 0.390) of two groups had no statistically significant differences. The short-term total effective rate of patients with the high LMR [82.8%(48/58)] was higher than that of patients with the low LMR [61.4% (43/70)] (P = 0.008). The median PFS time in the high LMR group (36 months) was longer than that in the low LMR group (19 months) (HR = 0.1295, 95% CI 0.081-0.206, P < 0.01). The median PFS time of the squamous cell carcinoma and adenocarcinoma, clinical stage Ⅱ B and stage Ⅲ A-Ⅳ A of the patients in the high LMR group (36, 31, 36, 36 months, respectively) was longer than that in the low LMR group (20, 15, 20, 18 months, respectively), and the differences were statistically significant (all P < 0.05). Univariate analysis showed that monocyte > 0.37×109/L, LMR ≤5.19, SCCA >15.24 U/ml were correlated with the poor prognosis of patients (all P < 0.05). Multivariate analysis showed that LMR ≤5.19 was an independent risk factor affecting the prognosis of patients (HR = 2.006, 95% CI 1.017-3.957, P = 0.045). Conclusion The peripheral blood LMR before the treatment can reflect the survival prognosis of patients with locally advanced cervical cancer, and low LMR indicates poor prognosis.