放(或/和)化疗前NLR、SII、PNI对进展期食管癌患者预后的预测价值

The predictive value of NLR, SII and PNI for prognosis of advanced esophageal cancer patients before radiotherapy (or/and) chemotherapy

目的评估外周血中性粒细胞/淋巴细胞比值(NLR)、全身免疫炎症指数(SII)、预后营养指数(PNI)对放(或/和)化疗前进展期食管癌患者预后的预测价值。方法回顾性分析292例进展期食管癌患者在接受放(或/和)化疗前临床、病理及影像学资料,根据NLR、SII、PNI的中位数分别分为高表达组和低表达组,Kaplan-Meier法分析放(或/和)化疗后5年生存率,Cox回归进行单因素和多因素分析两组患者的NLR、SII、PNI和临床病理学及影像学资料与患者预后的关系。结果 NLR、SII、PNI低表达组和高表达组5年生存率分别为24.4%、6.3%,24.8%、7.0%,9.5%、28.4%,差异均有统计学意义(P<0.05)。与单纯放疗或化疗者比较,放疗联合化疗者预后更好(P<0.05)。治疗前SII水平、PNI水平、治疗方式、N分期及cTNM分期是预测进展期食管癌患者预后的重要指标(P均<0.05)。结论低NLR及SII、高PNI、放疗与化疗联合治疗者预后更好,推荐联合治疗;放(或/和)化疗前外周血SII及PNI是预测进展期食管癌患者预后的重要指标。

Objective To evaluate the prognostic value of neutrophil-lymphocyte ratio(NLR), systemic immune-inflammatory index(SII), and prognostic nutritional index(PNI) in patients with advanced esophageal cancer undergoing radiotherapy(or/and) chemotherapy in peripheral blood. Methods The clinical, pathological and imaging data of 292 patients with advanced esophageal cancer before radiotherapy(or/and) chemotherapy were analyzed retrospectively. According to median values of NLR, SII and PNI, the patients were divided into high expression group and low expression group. 5-year survival after radiotherapy(or/and) chemotherapy was assessed by the Kaplan-Meier method. Cox regression model was used to analyze the relationship between NLR, SII, PNI, clinical, pathological and imaging data and prognosis of patient in both groups by univariate and multivariate analysis. Results The 5-year survival rates in low and high NLR, SII and PNI expression groups were 24.4% and 6.3%, 24.8% and 7.0%, 9.5% and 28.4%, respectively, with statistically significant differences(all P<0.05). Compared with radiotherapy or chemotherapy alone, radiotherapy combined with chemotherapy had a better prognosis(P<0.05). SII and PNI levels before treatment, treatment way, N stage and cTNM stage were important indicators to predict the prognosis of patients with advanced esophageal cancer(all P<0.05).Conclusion Patients with low NLR and SII, high PNI, radiotherapy combined with chemotherapy therapy have better prognosis, and combined therapy is recommended. SII and PNI in peripheral blood are important indicators to predict prognosis of patients with advanced esophageal cancer before radiotherapy(or/and) chemotherapy.