术前外周血SII、NLR、PLR对宫颈癌淋巴结转移的评估价值

Predictive value of peripheral blood SII,NLR and PLR before operation for lymph node metastasis in cervical cancer

目的探讨术前外周血系统免疫炎症指数(SII)、中性粒细胞与淋巴细胞比(NLR)、血小板与淋巴细胞比(PLR)与宫颈癌淋巴结转移的相关性,分析其预测价值。方法回顾性分析我院2016年1月至2020年1月收治的191例宫颈癌患者的临床资料,根据组织病理学淋巴结是否转移将其分为转移组(n=31)和未转移组(n=160)。采用单因素和多因素Logistic回归分析淋巴结转移的影响因素;通过受试者工作特征(ROC)曲线分析SII、NLR和PLR预测淋巴结转移的最佳界值和效能;分析SII、NLR和PLR与临床病理特征的关系。结果单因素分析显示,肿瘤≥4cm、脉管浸润、高SII、高NLR、高PLR的患者中淋巴结转移发生率较高(χ^(2)/Z值分别为4.532、8.342、14.363、4.837、11.478,P<0.05);多因素分析显示,肿瘤≥4cm(OR=2.347,95%CI:1.645~4.272)、脉管浸润(OR=1.924,95%CI:1.724~2.236)、高SII(OR=2.458,95%CI:1.557~1.968)、高PLR(OR=1.884,95%CI:1.418~8.654)是宫颈癌患者淋巴结转移的危险因素。ROC分析显示,SII、NLR和PLR预测宫颈癌淋巴结转移的界值分别为424.57、2.45和142.51,曲线下面积(AUC)分别为0.765、0.691、0.715,且三者联合的预测价值更高(AUC=0.836)。高SII组中高龄(≥50岁)、淋巴结转移、肿瘤≥4cm、ⅡA期、脉管浸润比例较高(P<0.05);高NLR和高PLR组中淋巴结转移、肿瘤≥4cm、脉管浸润比例较高(P<0.05)。结论SII、NLR和PLR是宫颈癌淋巴结转移的预测指标,三者联合的预测价值更高;高SII和高PLR是宫颈癌淋巴结转移的危险因素,具有一定的临床指导意义。

Objective To investigate correlations of peripheral systemic immune-inflammation index(SII),neutrophil to lymphocyte ratio(NLR)and platelet to lymphocyte ratio(PLR)before operation with lymph node metastasis in cervical cancer(CC).Methods The clinical data of 191patients with CC who were treated in our hospital from January 2016to January 2020were retrospectively analyzed.According to presence or absence of histopathological lymph node metastasis,they were divided into metastasis group(n=31)and non-metastasis group(n=160).Univariate and multivariate Logistic regressions were used to analyze influencing fac-tors of lymph node metastasis.The receiver operating characteristic(ROC)curve was used to analyze optimal thresholds and effi-ciencies of SII,NLR and PLR for predicting lymph node metastasis.The relationships of SII,NLR and PLR with clinicopathologic features were analyzed.Results Univariate analysis showed that in those CC patients with tumor′s size≥4cm,developing vascular invasion,high SII,high NLR and high PLR,the incidence of lymph node metastasis was higher(χ^(2)/Z=4.532,8.342,14.363,4.837 and 11.478,all P<0.05).Multivariate analysis showed that tumors′size≥4cm(OR=2.347,95%CI:1.645-4.272),vascular inva-sion(OR=1.924,95%CI:1.724-2.236),high SII(OR=2.458,95%CI:1.557-1.968),high PLR(OR=1.884,95%CI:1.418-8.654)were risk factors for lymph node metastasis in the patients with CC.The ROC curve analysis showed that the threshold val-ues of SII,NLR and PLR for predicting lymph node metastasis in CC were 424.57,2.45and 142.51respectively,and the areas un-der the curve(AUC)were 0.765,0.691and 0.715respectively,and the threshold value of the combination of the three was higher(AUC=0.836).The proportions of the CC patients with advanced age(≥50years old),lymph node metastasis,tumor′s size≥4cm,FIGO stageⅡA and vascular invasion were higher in the high SII group(all P<0.05).The proportions of the CC patients with lymph node metastasis,tumor′s size≥4cm and vascular invasion were higher in the both high NLR group and the high PLR group(all P<0.05).Conclusion SII,NLR and PLR are predictors of lymph node metastasis in CC.Moreover,the combination of the three has a higher predictive value.High SII and high PLR are risk factors for lymph node metastasis in CC,which have certain clinical guiding values.