治疗前淋巴细胞/单核细胞比值与中国食管鳞癌患者预后关系的Meta分析

Association between Pretreatment Lymphocyte/Monocyte Ratio and Prognosis of Esophageal Squamous Cell Carcinoma Patients in China: a Meta-analysis

目的探究治疗前淋巴细胞/单核细胞比值(lymphocyte/monocyte ratio,LMR)与中国食管鳞癌(Chinese esophageal squamous carcinoma,CESCC)患者预后的相关性。方法计算机检索PubMed、EMBASE、The Cochrane Library、Web of Science、CNKI、VIP、SinoMed等数据库公开发表的文献,检索时间为建库至2018年12月31日,收集有关LMR与CESCC患者预后关系的文献,应用Stata 12.0软件进行Meta分析,合并值为风险比(hazard ratio,HR),主要终点事件为总生存率(overall survival,OS),次要终点事件为无病生存率(disease-free survival,DFS)和肿瘤相关生存率(cancer-specific survival,CSS)。结果共纳入11项回顾性研究,总计4545例患者;Meta分析结果显示,相比于治疗前LMR较高的患者,LMR较低患者OS明显更低,差异有统计学意义[HR=1.49,95%置信区间(confidence interval,CI):1.25~1.79,P=0.000],伴较高异质性(I 2=58.5%);基于治疗方案和临界值的亚组分析进一步论证了LMR与OS的关系;同时,治疗前LMR也与DFS(HR=1.47,95%CI:1.24~1.74,P=0.000)、CSS(HR=1.64,95%CI:1.29~2.08,P=0.000)显著相关;通过逐一剔除单项研究的敏感度分析结果显示结论无显著改变,说明该项Meta分析的结论较为稳定、可靠;发表偏倚检测结果表明不存在显著的发表偏倚。结论治疗前LMR较低与CESCC患者预后不良存在显著联系,LMR可能是CESCC患者的一个独立预后影响因素,但仍需更多大样本的前瞻性研究进一步论证。

Objective To explore the relationship of pretreatment lymphocyte/monocyte ratio(LMR)with prognosis of Chinese esophageal squamous cell carcinoma(CESCC)patients.Methods PubMed,EMBASE,The Cochrane Library,Web of Science,CNKI,VIP and SinoMed databases were searched for eligible studies evaluating the predictive role of pretreatment LMR for the prognosis in CESCC from establishment of databases to December 31th,2018.The Stata 12.0 software was used to conduct the Meta-analysis and the pooled hazard ratio(HR)was used to assess the association between pretreatment LMR and prognosis of CESCC.Results A total of 4545 patients from 11 retrospective studies were included in the current Meta-analysis.The results showed that patients with low pretreatment LMR had a significantly worse overall survival(OS)than patients with high pretreatment LMR[HR=1.49,95%confidence interval(CI):1.25-1.79,P=0.000]with high heterogeneity(I 2=58.5%,P=0.013).Subgroup analyses based on the treatment method and cut-offs further demonstrated above findings.Meanwhile,the significant relation of pretreatment LMR with disease-free survival(DFS)(HR=1.47,95%CI:1.24-1.74,P=0.000)and cancer-specific survival(CSS)(HR=1.64,95%CI:1.29-2.08,P=0.000)was also observed.The results of sensitivity analysis for the OS by excluding one study at a time showed that the results were not obviously impacted,indicating the robustness of our findings.Begg′s and Egger′s tests did not show any publication bias.Conclusion There was a significant association between pretreatment LMR and prognosis in CESCC and LMR might be an independent prognostic factor of CESCC patients.However,more prospective studies with big sample size are still needed to testify our findings.