NLR、LMR和PLR水平与Ⅱb期宫颈鳞癌患者预后的相关性

Relationship Between NLR,LMR,PLR and the Prognosis of StageⅡb Squamous Carcinoma of the Cervix

目的探讨中性粒细胞-淋巴细胞比值(NLR)、淋巴细胞-单核细胞比值(LMR)和血小板-淋巴细胞比值(PLR)预测Ⅱb期宫颈鳞癌患者预后的相关性。方法回顾性分析2012年2月—2017年2月的105例Ⅱb期宫颈鳞癌患者的临床资料,计算NLR、LMR、PLR值,根据最佳截断值将患者分组,分析NLR、LMR、PLR与临床特征和无病进展生存期(PFS)的关系,并探讨影响患者预后的因素。结果患者PFS的NLR最佳截断值为2.47,患者分为高、低NLR组;LMR最佳截断值为5.19,患者分为高、低LMR组;PLR最佳截断值为135.32,患者分为高、低LMR组。NLR高低两组患者年龄(χ~2=0.457,P=0.499)、淋巴结转移(χ~2=1.602,P=0.206)、治疗方式(χ~2=0.296,P=0.586)、SCCA(χ~2=0.485,P=0.486),差异无统计学意义(P>0.05)。LMR高低两组患者年龄(χ~2=0.625,P=0.429)、治疗方式(χ~2=1.351,P=0.245)、SCCA (χ~2=2.418,P=0.120),差异无统计学意义(P>0.05);低LMR组中无淋巴结转移的患者21例,有淋巴结转移的患者35例,高LMR组中无淋巴结转移的患者34例,有淋巴结转移的患者15例,组间比较差异有统计学意义(χ~2=10.653,P=0.001)。PLR高低两组患者年龄(χ~2=1.818,P=0.178)、淋巴结转移(χ~2=0.001,P=0.969)、治疗方式(χ~2=0.015,P=0.902)、SCCA(χ~2=0.069,P=0.792),差异无统计学意义(P>0.05)。高NLR组中位PFS时间(19个月)低于低NLR组(32个月)(HR:0.329;95%CI:0.202~0.536,P<0.05)。高LMR组中位PFS时间(36个月)高于低LMR组(19个月)。提示两组生存曲线差异有统计学意义(HR:9.678;95%CI:5.70~16.440,P<0.05)。高PLR组中位PFS时间(22个月)低于低PLR组(30个月)。提示两组生存曲线差异有统计学意义(HR:0.492;95%CI:0.311~0.779。P<0.05)。单因素分析显示,LMR(≤5.19)、NLR(>2.47)、PLR(>135.32)、淋巴结转移(有)SCCA(>2.5 U/mL)与患者预后相关(P<0.05)。多因素分析显示LMR(≤5.19)(HR:0.513;95%CI:0.393~0.669,P<0.05),是影响患者预后的独立危险因素。结论 NLR、LMR、PLR均可能是Ⅱb期宫颈鳞癌患者预后的影响因素,LMR是影响预后的独立危险因素,LMR<5.19的患者预后差。

Objective To investigate the prognostic significance of the neutrophil-to-lymphocyte ratio(NLR),lymphocyte-to-monocyte ratio(LMR)and platelet-to-lymphocyte ratio(PLR)in patients with stageⅡb squamous carcinoma of the cervix.Methods A restropective review was performed on 105 patients who diagnosed squamous carcinoma of the cervix(stageⅡb),during February 2012 to February 2017.Calculate the NLR,LMR,PLR values.According to the optimal cutoff value,patients were divided into high and low groups.The clinical characteristics and progression-free survival of the two groups were compared and analyzed.At the same time,the factors affecting the prognosis of patients were discussed.Results The best cut-off value of NLR of patients with PFS was 2.47,and patients were divided into high and low NLR groups;the best cut-off value of LMR was 5.19,and patients were divided into high and low LMR groups;the best cut-off value of PLR was 135.32,and patients were divided into high and low LMR groups.Low LMR group.NLR high and low groups of patients with age(χ2=0.457,P=0.499),lymph node metastasis(χ2=1.602,P=0.206),treatment method(χ2=0.296,P=0.586),SCCA(χ2=0.485,P=0.486)The difference was not statistically significant(P>0.05).There was no significant difference in age(χ2=0.625,P=0.429),treatment method(χ2=1.351,P=0.245),SCCA(χ2=2.418,P=0.120)between the two groups of patients with LMR high and low(P>0.05);in the low LMR group,there were 21 patients without lymph node metastasis,35 patients with lymph node metastasis,34 patients without lymph node metastasis in the high LMR group,and 15 patients with lymph node metastasis.There were statistically significant differences between the groups(χ2=10.653,P=0.001).The age of the two groups of patients with high and low PLR(χ2=1.818,P=0.178),lymph node metastasis(χ2=0.001,P=0.969),treatment method(χ2=0.015,P=0.902),SCCA(χ2=0.069,P=0.792),The difference was not statistically significant(P>0.05).The median PFS time(19 months)in the high NLR group was lower than that in the low NLR group(32 months),indicating a significant difference in survival curves between the two groups(HR:0.329;95%CI:0.202~0.536.P<0.05).The median PFS time(36 months)in the high LMR group was higher than that in the low LMR group(19 months).It suggests that the difference in survival curves between the two groups is statistically significant(HR:9.678;95%CI:5.697~16.44,P<0.005).The median PFS time(22 months)in the high PLR group was lower than that in the low PLR group(30 months).it suggests that the difference in survival curves between the two groups is statistically significant(HR:0.492;95%CI:0.311~0.779 P<0.05).Univariate analysis showed that LMR(≤5.19),NLR(>2.47),PLR(>135.32),lymph node metastasis(with)SCCA(>2.5 U/mL)were related to the prognosis of patients(P<0.05).Multivariate analysis showed that LMR(≤5.19)(HR:0.513;95%CI:0.393~0.669,P<0.05)was an independent risk factor affecting the prognosis of patients.Conclusion NLR,LMR and PLR may be reflect the survival prognosis of patients with squamous carcinoma of the cervix(stageⅡb).LMR is independent risk factors affecting the prognosis and low LMR indicates poor prognosis.