术前炎症细胞比值与新辅助治疗食管癌患者术后肺炎及远期预后的相关性研究

Correlation between preoperative inflammatory biomarkers and postoperative pneumonia or long-term prognosis in patients with esophageal cancer after neoadjuvant therapy

目的探讨新辅助治疗后食管癌患者术前的炎症细胞比值与术后肺炎发生及远期预后的相关性。方法回顾性分析2016年1月至2019年5月四川大学华西医院胸外科收治的137例新辅助治疗后行食管癌根治术的患者的临床资料。男性111例,女性26例,年龄[M(QR)]61(10)岁(范围:45~75岁)。收集患者术前血常规资料,计算中性粒细胞淋巴细胞比值(NLR)、淋巴细胞单核细胞比值(LMR)、中性粒细胞单核细胞比值(NMR)。预后因素分析的终点指标为术后肺炎,采用χ^(2)检验、t检验或秩和检验进行数据比较,受试者工作特征曲线获取截点值,Logistic回归分析确定术后肺炎的独立预后因素。预后因素分析的终点指标是生存情况,X-Tile软件获取截点值,通过Cox比例风险回归模型进行生存分析,绘制Kaplan-Meier曲线,采用Log-rank检验验证。结果全组患者随访614(299)d(范围:382~1612 d),受试者工作特征曲线获取的NLR、LMR、NMR截点值分别为3.0、3.9、6.2。多因素Logistic回归分析结果显示,NLR>3.0(OR=2.740,95%CI:1.221~6.152,P=0.015)、LMR>3.9(OR=0.140,95%CI:0.022~0.890,P=0.037)是新辅助治疗后食管癌患者术后发生肺炎的独立预后因素。X-Tile软件获取的NLR、LMR、NMR截点值分别为3.3、4.2、7.2。多变量Cox比例风险回归分析结果显示,ypTNM分期晚(HR=2.087,95%CI:1.079~4.038,P=0.029)、病理未完全缓解(HR=2.251,95%CI:1.117~4.538,P=0.023)、LMR>4.2是新辅助治疗后食管癌患者的独立预后因素(HR=0.347,95%CI:0.127~0.946,P=0.039)。Kaplan-Meier生存曲线显示LMR≤4.2的患者总体生存率更低(82.9%比94.6%,P=0.002)。结论手术前LMR对预测新辅助治疗后食管癌患者的预后有一定价值。术前NLR>3.0或LMR≤3.9的新辅助治疗后食管癌患者,术后发生肺炎的概率较高;术前LMR≤4.2的患者,术后总体生存率较低。

Objective To examine the correlation between neutrophil-lymphocyte ratio(NLR),lymphocyte-monocyte ratio(LMR)and neutrophil-monocyte ratio(NMR)for postoperative pneumonia or long-term overall survival in patients with esophageal cancer after neoadjuvant therapy.Methods The clinical data of 137 patients,including 111 males and 26 females,with the age of(M(QR))61(10)years(range:45 to 75 years),undergoing radical resection of esophageal cancer after neoadjuvant therapy admitted at Department of Thoracic Surgery,West China Hospital from January 2016 to May 2019 were analyzed retrospectively.The blood routine one or two days before surgery and the occurrence of pneumonia after surgery were collected via hospital information system.The absolute count of neutrophils,lymphocytes and monocytes was recorded,to calculate NLR,LMR and NMR.The survival of patients was recorded systematically via follow-up.In the first part,the influencing factors of postoperative inflammation were analyzed,to group the patients into two groups according to the occurrence of postoperative pneumonia.χ^(2) test,t-test or rank-sum test were conducted for inter-group comparison.In the second part,cut-off values of inflammatory biomarkers were obtained with the receiver operating characteristic(ROC)curve and grouped,with postoperative pneumonia as endpoint criteria.Independent factors correlated with postoperative pneumonia were determined through univariate and multivariate Logistic regression analysis.In the third part,the analysis on prognosis factors was carried on,with the survival as endpoint criteria.Cut-off values of inflammatory biomarkers were obtained with X-Tile software and grouped.The survival analysis was carried on with univariate and multivariate Cox proportional hazards regression model,and the Kaplan-Meier curve was drawn finally.The results of survival analysis were verified by Log-rank test.Results Median follow-up time was 614(299)days(range:382 to 1612 days).Cut-off values of NLR,LMR,and NMR obtained via the ROC curve were 3.0,3.9,and 6.2,respectively.According to the multivariate Logistic regression analysis,NLR>3.0(OR=2.740,95%CI:1.221 to 6.152,P=0.015)and LMR>3.9(OR=0.140,95%CI:0.022 to 0.890,P=0.037)were independent prognosis factors for postoperative pneumonia in patients with esophageal cancer after neoadjuvant therapy.Cut-off values of NLR,LMR,and NMR obtained with X-Tile software were 3.3,4.2,and 7.2,respectively.Through multivariate Cox proportional risk regression analysis,late tumor ypTNM staging(8th AJCC)(HR=2.087,95%CI:1.079 to 4.038,P=0.029),poor pathologic response(HR=2.251,95%CI:1.117 to 4.538,P=0.023),and LMR>4.2(HR=0.347,95%CI:0.127 to 0.946,P=0.039)could be independent prognosis factors for overall survival.Kaplan-Meier survival analysis indicated that the overall survival of patients with LMR≤4.2 was worse(P=0.002),with the 1-year overall survival rate of 82.9%,and the 1-year overall survival rate of patients with LMR>4.2 was 94.6%.Conclusion Preoperative LMR≤3.9 and NLR>3.0 can be considered as independent prognosis factors for postoperative pneumonia,while LMR≤4.2 as one of independent prognosis factors for overall survival.