术前外周血淋巴细胞与单核细胞比值对宫颈鳞癌患者预后的预测价值

Predictive value of preoperative peripheral blood lymphocyte-to-monocyte ratio in cervical squamous carcinoma

目的探讨术前外周血淋巴细胞与单核细胞比值(LMR)对宫颈鳞癌患者预后的预测价值。方法回顾性分析2012年2月至2015年6月在宜宾市第一人民医院接受手术切除的宫颈鳞癌患者196例临床资料。通过建立受试者工作特征(ROC)曲线确定术前外周血LMR预测术后生存的最佳截点,并以此将患者分为低LMR和高LMR组。采用非参数分析乘积估计法(Kaplan-Meier)分析两组总生存期(OS)。采用多因素COX比例风险模型分析影响宫颈鳞癌患者预后的独立危险因素。结果ROC曲线结果显示:术前LMR预测宫颈鳞癌患者术后预后的最佳截点为4.57,按术前4.57为截点分为高LMR组和低LMR组;高LMR组与低LMR组在肿瘤大小、肿瘤FIGO分期、淋巴结转移和浸润深度、E-cadherin、Ki-67蛋白表达水平之间比较,差异均有统计学意义(均P<0.05);影响宫颈鳞癌患者OS的单因素分析显示,肿瘤大小、FIGO分期、淋巴结转移、浸润深度、E-cadherin、Ki-67蛋白表达水平、LMR均是宫颈鳞癌患者预后的影响因素(P<0.05);Kaplan-Meier生存曲线分析表明,高LMR组患者OS高于低LMR组患者(P<0.05);经多因素COX回归分析模型显示:术前低LMR值是宫颈鳞癌患者死亡的独立危险因素(P<0.05)。结论术前外周血LMR可作为预测宫颈鳞癌患者预后的标志物,对临床医生判断患者预后有指导意义。

Objective To explore the predictive value of preoperative peripheral blood lymphocyte-to-monocyte ratio(LMR)in the prognosis of patients with cervical squamous cell carcinoma.Methods A retrospective cohort of 196 patients who were newly diagnosed cervical squamous cell carcinoma and underwent surgical resection was recruited between February 2012 to June 2015,which collected from the the First People s Hospital of Yibin City.The best cut-off point for postoperative survival of the preoperative peripheral blood LMR was determined by establishing a receiver operating characteristic(ROC)curve,and the patients were divided into low LMR and high LMR groups.Kaplan-Meier method was used to analyze the total survival(OS)of the two groups.Multivariate COX proportional hazards analyses were applied to validate the LMR as an independent predictor of survival.Results Using the data collected from the whole cohort,the optimized LMR cut-off value selected on the ROC curve was 4.57 for the prognosis.According to preoperative LMR=4.57,it is divided into high LMR group and low LMR group.There were significant differences in the FIGO stage,lymph node metastasis,infiltration depth,E-cadherin and Ki-67 protein expression between the high LMR group and the low LMR group(P<0.05).Univariate analysis of OS in patients with cervical squamous cell carcinoma showed that tumor size,FIGO stage,lymph node metastasis,depth of invasion,E-cadherin,Ki-67 protein expression and LMR were all factors influencing the prognosis of patients with cervical squamous cell carcinoma(P<0.05).Kaplan-Meier survival curve analysis showed that the OS in high LMR group was higher than that in low LMR group(P<0.05).Multivariate COX regression analysis showed that preoperative low LMR was an independent risk factor for patients with cervical squamous cell carcinoma(P<0.05).Conclusions Preoperative peripheral blood LMR may be used as a predictor of prognosis in patients with cervical squamous cell carcinoma.