子宫颈癌患者术前外周血中性粒细胞与淋巴细胞比值、血小板与淋巴细胞比值及免疫指标与预后的相关性

Correlation of preoperative peripheral blood neutrophil-lymphocyte ratio and blood platelet-lymphocyte ratio and immune indexes with the prognosis of cervical cancer patients

目的探讨术前外周血中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)及免疫指标对子宫颈癌患者预后的评估价值。方法回顾性分析2017年5月至2018年9月山西省肿瘤医院收治的行根治性手术的283例子宫颈癌患者的临床资料, 选取100名同期健康体检者作为健康对照组。收集所有受试者血细胞检测结果及免疫细胞表达情况等。比较子宫颈癌患者与健康对照组及不同病理特征子宫颈癌患者外周血NLR和PLR。采用Kaplan-Meier法进行生存分析;采用Cox比例风险模型分析患者预后的影响因素。结果子宫颈癌组术前外周血NLR、PLR均高于健康对照组(NLR:2.53±1.35比2.00±1.21, t=5.35, P<0.001;PLR:163±57比144±38, t=4.71, P=0.006)。不同病理类型、肿瘤长径、脉管侵犯及神经侵犯患者外周血NLR、PLR差异均无统计学意义(均P>0.05), 不同临床分期及浸润肌壁程度患者外周血NLR、PLR差异均有统计学意义(均P<0.05)。术前CD3阳性细胞、CD4阳性细胞、CD8阳性细胞、CD19阳性细胞、CD56阳性细胞和CD127阳性细胞表达比例分别为60%~85%、30%~40%、<25%、8%~15%、15%~25%和<5%时, 患者总生存最好。单因素分析结果显示, 病理类型、临床分期、脉管侵犯及术前NLR、PLR、CD3阳性细胞、CD4阳性细胞、CD8阳性细胞、CD19阳性细胞、CD56阳性细胞和CD127阳性细胞均为子宫颈癌患者总生存的影响因素(均P<0.05)。多因素分析结果显示, 临床分期、脉管侵犯、术前NLR、术前PLR和术前CD4阳性细胞均为子宫颈癌患者总生存的独立影响因素(均P<0.05)。结论术前外周血高NLR和PLR对子宫颈癌患者临床病理特征及不良预后有一定的影响;当外周血中免疫细胞处于动态平衡时, 子宫颈癌患者的预后最佳。

Objective To evaluate the value of preoperative peripheral blood neutrophil-lymphocyte ratio(NLR)and blood platelet-lymphocyte ratio(PLR)and immune indexes in the evaluation of the prognosis of cervical cancer patients.Methods The clinical data of 283 patients with cervical cancer who underwent radical surgery in Shanxi Province Cancer Hospital from May 2017 to September 2018 were retrospectively analyzed,and 100 healthy people who underwent physical examination during the same period were collected as the healthy control group.Test results of blood cells and immune cells expressions of all subjects were collected.Peripheral blood NLR and PLR of cervical cancer patients,people in the healthy control group and cervical cancer patients with different pathological characteristics were compared.Kaplan-Meier method was used to make survival analysis and Cox regression risk model was used to analyze the factors influencing the prognosis of patients with cervical cancer.Results The preoperative peripheral blood NLR and PLR in patients with cervical cancer was higher than that of the healthy control group(NLR:2.53±1.35 vs.2.00±1.21,t=5.35,P<0.001;PLR:163±57 vs.144±38,t=4.71,P=0.006).Pathological results showed that there were no statistically significant differences in NLR and PLR in peripheral blood of cervical cancer patients with different pathological types,tumor diameter,vascular invasion,and nerve invasion(all P>0.05),while there were statistically significant differences in NLR and PLR in peripheral blood of cervical cancer patients with different clinical staging and muscle wall invasion(all P<0.05).When the proportions of the expression levels of preoperative CD3 positive cells,CD4 positive cells,CD8 positive cells,CD19 positive cells,CD56 positive cells,and CD127 positive cells were 60%-85%,30%-40%,<25%,8%-15%,15%-25%and<5%,respectively,the overall survival of cervical cancer patients was the best.Univariate analysis showed that pathological type,clinical staging,vascular invasion,preoperative NLR,preoperative PLR,CD3 positive cells,CD4 positive cells,CD8 positive cells,CD19 positive cells,CD56 positive cells and CD127 positive cells were influencing factors of the overall survival of cervical cancer patients(all P<0.05).Multivariate analysis showed that clinical staging,vascular invasion,preoperative NLR,preoperative PLR,and preoperative CD4 positive cells were independent influencing factors for the overall survival of cervical cancer patients(all P<0.05).Conclusions Preoperative high NLR and PLR in peripheral blood have a certain impact on the clinicopathological characteristics and poor prognosis of cervical cancer patients.When the immune cells in peripheral blood are in dynamic balance,the prognosis of cervical cancer patients is the best.