治疗前NLR和肌肉减少症对局部晚期子宫颈鳞癌患者预后的影响

Effect of pre-treatment NLR and sarcopenia on prognosis of patients with locally advanced cervical squamous cell carcinoma

目的探讨局部晚期子宫颈癌患者肌肉减少症发生率与临床病理特征的关系,评估治疗前系统炎性反应与肌肉减少症对患者总生存时间(overall survival,OS)的影响。方法回顾性分析107例ⅠB2~ⅢB期子宫颈鳞癌患者的临床资料和随访资料。以中性粒细胞与淋巴细胞比例(neutrophil to lymphocyte ratio,NLR)≥3为存在系统炎性反应。采用χ^2检验分析肌肉减少症发生率与临床病理特征的关系。采用Kaplan-Meier法比较总生存。Cox多因素分析晚期子宫颈鳞癌预后独立危险因素。结果≥60岁与<60岁患者以及NLR<3和NLR≥3的患者肌肉减少症发生率比较,差异均具有统计学意义(55.6%vs 44.4%,P=0.021;25.0%vs 75.0%,P=0.001)。肌肉减少症合并NLR≥3组患者5年总生存率较低(P=0.040)。多因素分析显示,肌肉减少症及NLR≥3为晚期子宫颈鳞癌预后独立危险因素(均P<0.05)。结论局部晚期子宫颈鳞癌患者治疗前肌肉减少症可能与系统炎性反应有关。肌肉减少症合并系统炎性反应的患者预后较差。肌肉减少症及高NLR是子宫颈鳞癌预后独立危险因素。

Objective To investigate the relationship between the incidence of sarcopenia and clinicopathological characteristics in patients with locally advanced cervical squamous cell carcinoma,and to evaluate the effect of pre-treatment systemic inflammatory response and sarcopenia on these patients’overall survival(OS).Methods The clinical data of 107 patients with stageⅠB2-ⅢB cervical squamous cell carcinoma were retrospectively analyzed.A systemic inflammatory response was observed with a neutrophil to lymphocyte ratio(NLR)≥3.χ^2 test was used to analyze the relationship between the incidence of sarcopenia and clinicopathological features.The overall survival was compared using the Kaplan-Meier method.Cox multivariate analysis was used to identify independent risk factors for advanced cervical squamous cell carcinoma.Results There was a statistically significant difference in the incidence of sarcopenia between patients older than 60 years old and patients younger than 60 years old,and patients with NLR<3 and patients with NLR≥3(55.6%vs 44.4%,P=0.021;25.0%vs 75.0%,P=0.001).The 5-year OS rate was lower in patients with sarcopenia and NLR≥3(P=0.040).Multivariate analysis showed that sarcopenia and NLR≥3 were independent risk factors for the prognosis of advanced cervical squamous cell carcinoma.Conclusions Sarcopenia may be related to systemic inflammatory response before treatment,and locally advanced cervical squamous cell carcinoma patients with sarcopenia and systemic inflammatory response have a poor prognosis.Sarcopenia and high NLR are independent risk factors for the prognosis of cervical squamous cell carcinoma.