术前NLR-PLR评分对乳腺癌患者预后的影响及相关因素分析

Effect of preoperative NLR-PLR score on the prognosis of breast cancer patients and analysis of related factors

目的分析术前外周血中性粒细胞与淋巴细胞比值(NLR)和血小板与淋巴细胞比值(PLR)联合评分对乳腺癌患者预后的影响及其与临床病理学参数的相关性。方法选择行根治性乳腺癌手术的患者304例。利用受试者工作特征(ROC)曲线确定NLR及PLR临界值,采用Kaplan-Meier法绘制生存曲线,采用COX回归模型进行单因素和多因素分析,基于生存结局绘制ROC曲线,并对NLR-PLR评分和单一炎症指标的预后价值进行比较。结果NLR-PLR评分与乳腺癌患者的年龄(P=0.022)、月经状态(P=0.026)、肿瘤大小(P=0.041)、TNM分期(P=0.028)、淋巴结转移(P=0.042)和术后放疗(P=0.002)有关。NLR-PLR评分为0分的患者生存时间与评分为1分、2分的患者生存时间比较,差异均有统计学意义(χ20,1=8.540,P=0.003;χ20,2=22.382,P<0.001);NLR-PLR评分为1分的患者生存时间与NLR-PLR评分为2分的患者生存时间比较,差异有统计学意义(χ21,2=4.279,P=0.039)。单因素分析结果显示肿瘤大小、TNM分期、雌激素受体(ER)、孕激素受体(PR)、淋巴结转移、NLR-PLR评分是影响乳腺癌患者预后的相关因素(P<0.05);多因素分析结果显示TNM分期、淋巴结转移、NLR-PLR评分是乳腺癌患者预后的独立影响因素(P<0.05)。NLR-PLR评分的ROC曲线下面积(AUC)大于NLR、PLR和LMR单一炎症指标的AUC(P<0.001)。结论NLR-PLR评分与乳腺癌患者临床病理学参数密切相关,是乳腺癌患者预后的独立影响因素,NLR-PLR评分越高的患者生存时间越短。

Objective To investigate the effect of the combined score of neutrophil-to-lymphocyte ratio(NLR)and platelet-to-lymphocyte ratio(PLR)in the preoperative peripheral blood on the prognosis of breast cancer patients and its correlation with clinicopathological parameters.Methods A total of 304 patients who underwent radical breast cancer surgery were selected.The critical values of NLR and PLR were determined by receiver operating characteristic(ROC)curve.The survival curve was drawn by Kaplan-Meier method.The univariate and multivariate analysis were performed by COX regression model,and the ROC curve was drawn based on the survival outcome.And the prognostic value of NLR-PLR score and single inflammatory index were compared.Results The NLR-PLR score was related to the age(P=0.022),menstrual status(P=0.026),tumor size(P=0.041),TNM stage(P=0.028),lymph node metastasis(P=0.042)and postoperative radiotherapy(P=0.002)of breast cancer patients.There were statistically significant differences in the survival time of patients with NLR-PLR score of 0 and that of patients with scores of 1 and 2(χ20,1=8.540,P=0.003;χ20,2=22.382,P<0.001).There was statistically significant difference between the survival time of patients with NLR-PLR score of 1 and that of patients with NLR-PLR score of 2(χ21,2=4.279,P=0.039).The results of univariate analysis showed that tumor size,TNM stage,estrogen receptor(ER),progesterone receptor(PR),lymph node metastasis,and NLR-PLR score were the related factors affecting the prognosis of breast cancer patients(P<0.05),while the results of multivariate analysis showed that TNM stage,lymph node metastasis,and NLR-PLR score were the independent factors affecting the prognosis of breast cancer patients(P<0.05).The area under curve(AUC)of ROC of NLR-PLR score was larger than the AUC of the single inflammatory index of NLR,PLR and LMR(P<0.001).Conclusion NLR-PLR score is closely related to the clinicopathological parameters of breast cancer patients,and it is an independent factor affecting the prognosis of breast cancer patients.The higher the NLR-PLR score,the shorter the survival time of patients.