NLR联合AGR评估食管鳞状细胞癌患者预后的临床价值

Clinical value of NLR combined with AGR in evaluating the prognosis of patients with esophageal squamous cell carcinoma

目的探讨中性粒细胞-淋巴细胞计数比率(NLR)、白蛋白-球蛋白比率(AGR)与食管鳞状细胞癌(ESCC)患者总生存(OS)期的关系,评估两项指标联合对预测ESCC患者预后的应用价值。方法本研究回顾性分析了自2015年01月至2019年12月间于南通大学附属如皋医院首诊并接受手术治疗的144例ESCC患者的血常规、血生化检测结果与随访数据。通过受试者操作特征(ROC)曲线确定NLR、AGR的最佳临界值,利用曲线下面积(AUC)评估各指标对ESCC患者OS期的预测效能。通过Kaplan-Meier曲线及Cox单、多变量回归分析评估两种预测指标的预后价值。结果根据期曲线,NLR与AGR预测ESCC患者OS期的最佳截断值分别为1.45和1.48,AUC值分别为0.713(95%CI=0.628~0.797)和0.673(95%CI=0.584~0.761)。Kaplan-Meier曲线展示高NLR(>1.45)与低NLR(≤1.45)组患者的中位OS期分别为51.8个月(95%CI=36.2~67.3)和20.1个月(95%CI=14.1~26.2),差异有统计学意义(χ^(2)=20.474,P<0.001)。术前低AGR值(<1.48)与ES-CC患者不良预后显著相关[中位OS期:22.5个月(95%CI=15.1~29.9)比43.3个月(95%CI=25.7~60.8)],差异有统计学意义(χ^(2)=6.749,P=0.009)。单、多变量Cox分析证实淋巴结转移(HR=3.626,95%CI=2.152~6.110,P<0.001)、NLR(HR=1.960,95%CI=1.198~3.207,P=0.007)与AGR(HR=1.791,95%CI=1.099~2.920,P=0.019)是ESCC患者的独立预后因素。此外,我们发现NLR联合AGR评分(0分:NLR≤1.45且AGR≥1.48;1分:NLR>1.45或AGR<1.48;2分:NLR>1.45且AGR<1.48)能够进一步分层ESCC患者的预后,患者评分越高,预后越差。0分、1分与2分患者的中位OS期分别为56.6个月(95%CI=40.2~67.3)、29.9个月(95%CI=20.1~39.8)和18.2个月(95%CI=12.1~24.3),组间差异有统计学意义(0分比1分:χ^(2)=6.795,P=0.009;0分比2分:χ^(2)=19.529,P<0.001;1分比2分:χ^(2)=7.011,P=0.008)。结论NLR与AGR是评估ESCC患者预后的敏感指标,两者联合可以更有效地识别预后不良患者,进而提供更为详尽的预后分层。

Objective To investigate the correlations between neutrophil-to-lymphocyte ratio(NLR)as well as albumin-toglobulin ratio(AGR)and overall survival(OS)of esophageal squamous cell carcinoma(ESCC)patients,and evaluate the prognostic value of their combination.Method A total of 144 ESCC patients who were initially diagnosed and treated with surgical resection in our institution from January 2015 to December 2019 were included in this study,and their data of laboratory test and postoperative followup were retrospectively collected and analyzed.The best thresholds of NLR and AGR were determined by receiver operation characteristics(ROC)curve,and the area under curve(AUG)value was used to evaluate their predictive performance.The prognostic values of NLR and AGR for ESCC patients were evaluated using Kaplan-Meier method and the multivariate Cox regression analysis.Result According to the ROC curves,the optimal cut-off values of NLR and AGR for survival prediction of ESCC patients were 1.45 and 1.48,respectively.The AUC values of NLR and AGR were 0.713(95%CI=0.628-0.797)and 0.673(95%CI=0.584-0.761),respectively.Kaplan-Meier curves indicated that the median OS of patients with high NLR(>1.45)and low NLR(≤1.45)was 51.8 months(95%CI=36.2-67.3)and 20.1 months(95%CI=14.1-26.2),with a significantly statistical difference(χ^(2)=20.474,P<0.001).In contrast,preoperative low AGR(<1.48)was significantly associated with poor OS of ESCC patients[median OS:22.5 months(95%CI=15.1-29.9)vs 43.3 months(95%CI=25.7-60.8);χ^(2)=6.749,P=0.009].The univariate and multivariate Cox analysis identified lymph node metastasis(HR=3.626,95%CI=2.152-6.110,P<0.001),NLR(HR=1.960,95%CI=1.198-3.207,P=0.007)and AGR(HR=1.791,95%CI=1.099-2.920,P=0.019)as independent prognostic factors for ESCC patients.Additionally,we found that the prognosis of ESCC patients could be further stratified by the combination of NLR and AGR(0 point:NLR≤1.45 and AGR≥1.48;1 point:NLR>1.45 or AGR<1.48;2 point:NLR>1.45 and AGR<1.48).The higher score,the poorer OS in ESCC patients.The median OS of patients with 0,1 and 2 points were 56.6 months(95%CI=40.2-67.3),29.9 months(95%CI=20.1-39.8)and 18.2 months(95%CI=12.1-24.3),respectively.There were significant survival differences between different patient groups(0 vs 1 point:χ^(2)=6.795,P=0.009;0 vs 2 points:χ^(2)=19.529,P<0.001;1 vs 2 points:χ^(2)=7.011,P=0.008).Conclusion NLR and AGR were identified as sensitive predictors of prognostic assessment,and their combination could provide a proper prognostic stratification for ESCC patients.