中性粒细胞-淋巴细胞比值、血小板-淋巴细胞比值对预测晚期非小细胞肺癌患者化疗疗效及预后的意义

Prognostic significance of neutrophil lymphocyte ratio and platelet-lymphocyte ratio in patients with advanced non-small cell lung cancer

目的探讨化疗前后中性粒细胞-淋巴细胞比值(neutrophil lymphocyte ratio,NLR)、血小板-淋巴细胞比值(platelet lymphocyte ratio,PLR)及其动态变化对驱动基因阴性晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)患者接受化疗疗效及预后的意义。方法分析2012年1月—2016年12月在空军特色医学中心接受化疗的94例晚期NSCLC患者,观察基线时NLR0、PLR0以及2周期化疗后NLR2、PLR2水平,分析NLR、PLR与其临床病理特征的关系,并采用COX回归分析NLR、PLR及其动态变化对晚期NSCLC患者预后的意义。结果NLR0与患者病理类型、年龄有关(P<0.05),且年龄大、鳞癌的晚期NSCLC患者NLR0高于年龄较小及腺癌者,NLR0与患者分期、性别等无关(P>0.05);PLR0仅病理类型有关(P=0.004),与其他临床病理特征无关。低NLR0低NLR2组和高NLR0低NLR2组的近期化疗疗效明显优于高NLR0高NLR2组和低NLR0高NLR2组(P=0.000),PLR动态变化与化疗疗效的关系和NLR动态变化相似(P=0.000)。Kaplan-Meier生存分析显示患者病理类型、2周期化疗疗效、NLR0、NLR2、PLR2及NLR的动态变化与晚期NSCLC患者预后有关(P<0.05),COX多因素回归分析表明患者病理类型、2周期化疗疗效、NLR0、及NLR的动态变化是影响NSCLC患者预后的独立危险因素(P<0.05)。结论化疗前后NLR、PLR动态变化与晚期NSCLC患者化疗疗效相关;基线时NLR、及化疗前后NLR的动态变化对预测晚期NSCLC患者的预后有一定价值。

Objective To explore the predictive value of the neutrophil-lymphocyte ratio(NLR)and platelet-lymphocyte ratio(PLR)before and after chemotherapy in patients with drive-gene-negative non-small cell lung cancer(NSCLC)and receiving first-line chemotherapy.Methods The clinical data on 94 patients with advanced NSCLC who had received chemotherapy in our hospital between January 2012 and December 2016 The levels of NLR0 and PLR0 at baseline and after 2 cycles of chemotherapy were observed,was retrospectively analyzed.The relationship between NLR,PLR and their clinicopathological characteristics was probed.COX regression analysis was used to study the significance of NLR,PLR and its dynamic changes in prognosis of patients with advanced NSCLC.Results NLR0 was correlated with the pathological type and age of patients(P<0.05),and the NLR0 of older patients with advanced NSCLC and squamous cell carcinoma was higher than that of younger ones with adenocarcinoma.NLR0 was not correlated with staging or gender(P>0.05).PLR0 was not associated with other clinicopathological features except for the pathological type(P=0.004).The efficacy of recent chemotherapy in the low NLR0 low NLR2 and high NLR0 low NLR2 groups was significantly better than in the high NLR0 high NLR2 and low NLR0 high NLR2 groups(P=0.000).PLR was similar to NLR in terms of the relationgship between dynamic changes and the efficacy of two cycles of chemotherapy(P=0.000).Kaplan and Meier survival analysis showed that gender,pathological types,efficacy of two cycles of chemotherapy,NLR0,NLR2,PLR2 and dynamic changes of NLR were related to the prognosis of patients with advanced NSCLC(P<0.05),Cox multiple factors analysis showed the pathological type,two cycles of chemotherapy,NLR0 and dynamic changes of NLR were independent risk factors affecting the prognosis of patients with NSCLC(P<0.05).Conclusion The dynamic changes of NLR and PLR are correlated with the efficacy of chemotherapy in patients with advanced NSCLC.The baseline NLR and dynamic changes of NLR before and after chemotherapy are significant for predicting the prognosis of patients with advanced NSCLC.