中性粒细胞及乳酸脱氢酶水平对食管鳞癌患者同步放化疗的预后判断价值

Prognostic Value of Neutrophil Counts and Lactate Dehydrogenase Levels in Esophageal Squamous Cell Carcinoma after Radiotherapy

[目的]探讨中性粒细胞和乳酸脱氢酶(LDH)水平对食管鳞癌(ESCC)患者预后的预测价值,并建立预后风险评分模型来预测ESCC患者的预后。[方法]回顾性收集接受放射治疗的189例ESCC患者资料,分析LDH和中性粒细胞水平与临床病理特征的关系,并确定ESCC患者的预后影响因素。以多因素分析结果为基础,建立预后风险评分模型,并对其在亚组中的预测能力进行验证。[结果](1)189例患者的LDH中位值为208.0 U/L,中性粒细胞的中位值为4.8×10^(9)/L,利用ROC曲线确定二者预测完全缓解率(CR)的最佳临界值分别为220 U/L和4.5×10^(9)/L。(2)根据临界值,将患者分别分为LDH≤220 U/L组(n=116)和LDH>220 U/L组(n=73);中性粒细胞≤4.5×10^(9)/L组(n=83)和中性粒细胞>4.5×10^(9)/L组(n=106)。患者N分期与LDH水平明显相关(P<0.05);患者性别、T分期、N分期、TNM分期对中性粒细胞水平有明显影响(P<0.05)。(3)多因素分析显示,性别、T分期、N分期、LDH水平和中性粒细胞计数是影响患者无复发生存率(RFS)、总生存率(OS)的独立性危险因素。(4)根据多因素分析结果,构建一个基于性别、T分期、N分期、LDH水平和中性粒细胞计数的预后风险模型。在该模型中,低风险组(n=14):无预后不良因素或有1个预后不良因素;中等风险组(n=141):有2~3个预后不良因素;高风险组(n=34):有4~5个不良预后因素。低、中、高风险组患者的中位OS分别为101.20个月、18.00个月和10.05个月,差异有统计学意义(χ2=27.38,P<0.001)。[结论]基线LDH水平和中性粒细胞计数与行放射治疗ESCC患者的预后密切相关,构建的包含LDH、中性粒细胞计数在内的预后模型有助于判断患者预后。

[Objective]To investigate the prognostic value of neutrophil counts and lactate dehydrogenase(LDH)in patients with esophageal squamous cell carcinoma(ESCC)and to establish a prognostic risk score model.[Methods]The clinical data of 189 ESCC patients undergoing radiotherapy were collected,the relationship of LDH and neutrophil levels with clinicopathological features was analyzed and the prognostic factors for ESCC patients after radiotherapy were determined.Based on the results of multivariate analysis,a prognostic risk score model was established and validated.[Results]The median of LDH and neutrophil counts in 189 ESCC patients were 208.0 U/L and 4.8×10^(9)/L,respectively.The optimal cut-off values of LDH and neutophil for predicting complete remission(CR)were 220 U/L and 4.5×10^(9)/L,respectively.There were 116 cases with LDH≤220 U/L,73 cases with LDH>220 U/L;83 cases with neutrophils≤4.5×10^(9)/L and 106 cases with neutrophils>4.5×10^(9)/L.The LDH level was significantly correlated with N stage(P<0.05);the neutrophil level was significantly associated with gender,T stage,N stage and TNM stage of patients(P<0.05).Multivariate analysis showed that gender,T stage,N stage,LDH level and neutrophil count were independent risk factors for RFS and OS.According to the results of multivariate analysis,a prognostic risk model was constructed.According to the model score,there were 14 cases with no or one adverse prognostic factor(low-risk group),141 cases with 2~3 adverse prognostic factors(moderate risk group),and 34 cases with 4~5 adverse prognostic factors(high-risk group).The median OS of low,medium and high risk groups were 101.20 months,18.00 months and 10.05 months,respectively(χ2=27.38,P<0.001).[Conclusion]The baseline LDH level and neutrophil count are closely related to the prognosis of ESCC patients undergoing radiotherapy.The established prognosis model including LDH and neutrophil count is helpful to predict the prognosis of patients.