术前中性粒细胞和淋巴细胞比值对肾上腺皮质癌的预后评估研究

Prognostic evaluation of adrenocortical carcinoma by preoperative neutrophil and lymphocyte ratio

目的研究分析术前中性粒细胞和淋巴细胞比值(NLR)对肾上腺皮质癌(ACC)患者的预后影响。方法回顾性分析我院2009年5月至2019年10月收治的22例肾上腺皮质癌患者的临床资料,统计其年龄、体质指数(BMI)、肿瘤直径、中性粒细胞、淋巴细胞、白蛋白、血红蛋白等相关数据,电话随访明确每个患者的生存状况、无进展生存时间(PFS)及总生存时间(OS),采用ROC曲线确定NLR最佳临界值,分为高NLR组和低NLR组,分别统计并比较两组患者年龄、BMI、肿瘤最大径、白蛋白、血红蛋白(Hb)、血糖、OS、PFS等临床数据,通过Kaplan-Meier法进行生存分析,绘制生存曲线,并通过Cox回归模型进行多因素分析,明确ACC患者的独立预后因子。结果根据ROC曲线,NLR的cut off值为2.479,按NLR>2.479和NLR≤2.479将患者分为两组,高NLR组的白蛋白水平显著低于低NLR组,差异有统计学意义(P<0.05),而高NLR组患者的平均年龄、血糖水平高于低NLR组,两组差异有统计学意义(P<0.05),高NLR组的PFS为6(2.25,18.00)个月,OS为18.5(7.50,29.75)个月,而低NLR组PFS为31.5(19.25,74.25)个月,OS为42(25.75,74.25)个月,两组差异有统计学意义(P<0.05)。通过单因素及多因素分析后,本组发现高NLR组发生转移的概率高(HR=7.402,95%CI:1.662~32.963),且死亡的风险大(HR=13.713,95%CI:1.287~146.093)。结论 NLR高低对于ACC患者的预后具有较高的评估价值。

Objective To study the effect of preoperative neutrophil and lymphocyte ratio(NLR) on the prognosis of patients with adrenocortical carcinoma(ACC).Methods Basic clinical data of 22 patients with adrenocortical cancer from May 2009 to October 2019 in our hospital,including their age,BMI,tumor diameter,neutrophils,lymphocytes,albumin,hemoglobin were analyzed retrospectively.The months of progression-free survival(PFS) and overall survival(OS) of each patient were followed by using telephone.The ROC curve was used to determine the optimal NLR cut-off value,all the patient were divided into high NLR and low NLR groups according to the cut-off value.Clinical data such as age,BMI,tumor diameter,albumin,hemoglobin,blood glucose,OS,and PFS were compared between the two groups.Survival analysis was performed by Kaplan-Meier method,survival curves were drawn,and multivariate analysis was performed by Cox regression model to determine independent prognostic factors for patients with ACC.Results According to the ROC curve,patients were divided into two groups including NLR>2.479 and NLR≤2.479.The serum albumin level in the high NLR group was significantly lower than that in the low NLR group,which was statistically different(P<0.05).Age and blood glucose levels were higher in the high NLR group than those in the low NLR group,and there was a statistical difference between the two groups(P<0.05).The average progression-free survival time(PFS) of the high NLR group was 6(2.25,18.00)months,and the average total survival time(OS) was 18.5(7.50,29.75)months.The low NLR group had an average progression-free survival time of 31.5(19.25,74.25) months and an average total survival time of 42(25.75,74.25) months.There was a significant difference between the two groups(P<0.05).After univariate analysis and multivariate analysis,we found that the probability of metastasis was high(HR=7.402,95%CI:1.662-32.963) in the high NLR group and the risk of death was high(HR=13.713,95%CI:1.287-146.093) in the high NLR group.Conclusion The level of NLR has a higher application value for the prognosis of ACC patients.