外周血中性粒细胞与淋巴细胞比值变化对非小细胞肺癌放疗近期疗效的预测价值

Value of neutrophil to lymphocyte ratio as a predictor of short-term efficacy in radiation(RT)-treated non-small cell lung cancer(NSCLC)

目的:外周血中白细胞的成分和计数不仅可以反映肿瘤微环境的炎症反应,还被认为是潜在有意义的肿瘤预后指标。本研究旨在评估晩期非小细胞肺癌患者胸部放疗对外周血淋巴细胞计数的影响,并分析放疗后中性粒细胞与淋巴细胞比值变化对近期疗效的预测价值。方法:回顾性分析了自2017年1月1日〜2018年9月1日在山东第一医科大学第三附属医院放疗中心放疗的非小细胞肺癌患者在放疗前、放疗中、放疗结束时、放疗后1月的血常规,记录各时间点的淋巴细胞计数值(lymphocyte,L值),并计算相应中性粒细胞与淋巴细胞比值(neutrophil to lymphocyte ratio,NLR),按照CTCAE 4.03标准对淋巴细胞计数降低进行分级,分析有效和无效两组放疗后的L值及NLR值有无统计学差异。结果:入组患者在放疗过程中和放疗后均发生不同程度的淋巴细胞计数降低,56.76%发生3-4级淋巴细胞计数降低。统计分析显示,有效组和无效组的放疗后L值、放疗后NLR值,放疗后1月L值、放疗后1月NLR值均无统计学差异。结论:放疗后淋巴细胞计数降低及NLR值与近期疗效无相关性,仍需前瞻性大样本研究证实。

Objective:The composition and count of white blood cells in peripheral blood can not only reflect the inflammatory response of tumor microenvironment,but also be considered as a potential and meaningful predictor of prognosis of cancer.The purpose of this study was to evaluate the effect of thoracic radiotherapy on peripheral blood lymphocyte count in patients with advanced non-small cell lung cancer,and to analyze the predictive value of neutrophil to lymphocyte ratio after radiotherapy for short-term efficacy.Methods:The blood routine examination of patients with non-small cell lung cancer treated in the radiotherapy center of the Third Affiliated Hospital of Shandong First Medical University from January 2017 to September 2018 were analyzed retrospectively.The lymphocyte counts(L values)at each time point including before start of RT,during RT,end day of RT and one month post-RT were recorded and the corresponding neutrophil to lymphocyte ratios(NLR)were calculated.The difference of L value and NLR value between the effective group and ineffective group after radiotherapy was analyzed.Results:The lymphocyte count decreased in varying degrees during and after radiotherapy in all the patients,56.76% of them had grade 3-4 lymphopenia.Statistical analysis showed that there were no significant differences in L value immediately after radiotherapy,NLR value immediately after radiotherapy,L value in 1 month after radiotherapy and NLR value in 1 month after radiotherapy between effective group and ineffective group.ConClusion:The lymphopenia and NLR value after radiotherapy has no correlation with the short-term efficacy,which still needs to be confirmed by prospective large sample studies.