淋巴细胞-单核细胞比值在老年食管癌根治性放化疗患者预后中的临床意义

Clinical significance of lymphocyte-monocyte ratio in the prognosis of elderly patients undergoing curative chemoradiotherapy for esophageal cancer

目的分析根治性放化疗前淋巴细胞-单核细胞比值(lymphocyte-to-monocyte ratio,LMR)对老年食管癌(esophagus cancer,EC)患者预后的评估价值。方法收集2014年1月—2017年12月在蚌埠医学院第一附属医院放射肿瘤科接受EC根治性放化疗的老年(≥65岁)患者220例,回顾性分析所纳入患者的临床数据及实验室检验指标。通过建立受试者工作特征曲线,约登指数最大值时的LMR为4.9,将LMR=4.9作为临界值,分为高LMR组(>4.9,69例)和低LMR组(≤4.9,151例),通过Kaplan-Meier方法绘制2组患者的生存曲线,采用Log Rank法比较2组患者的生存状况,通过Cox回归模型进行多因素分析。结果全组共有82例患者生存,总体中位随访时间为45个月,总体中位生存时间为28个月。高LMR组和低LMR组患者的5年无进展生存率分别为38.6%和29.8%(P=0.005),5年总生存率分别为47.0%和26.5%(P=0.003)。Cox回归模型多因素分析结果显示,根治性放化疗前LMR值是老年EC患者预后的独立影响因素(HR=0.634,95%CI:0.422~0.954,P=0.029)。结论对于接受根治性放化疗的老年EC患者来说,根治性放化疗前LMR降低是独立不良预后因素。

Objective To analyze the prognostic value of lymphocyte to monocyte ratio(LMR)in elderly patients with esophageal cancer(EC).Methods A total of 220 elderly(≥65 years)patients who underwent radical chemoradiotherapy for EC at the Radiation Oncology Department of the First Affiliated Hospital of Bengbu Medical College from January 2014 to December 2017 were enrolled,and the clinical data and laboratory test indexes of the included patients were retrospectively reviewed.By constructing receiver operating characteristic curve,the LMR at the maximum value of Youden index was 4.9,and LMR=4.9 was used as the cut-off value to divide the patients into high LMR group(>4.9,69 cases)and low LMR group(≤4.9,151 cases),the survival curves of the two groups were plotted by Kaplan-Meier method,log-rank method to compare the survival status of the two groups,and multivariate analysis was performed by Cox regression model.Results A total of 82 patients were alive in the whole group with a median overall follow-up of 45 months and a median overall survival time of 28 months.The 5-year progression-free survival rates of patients in the high and low LMR groups before radical chemoradiotherapy were 38.6%and 29.8%,respectively(P=0.005),and the 5-year overall survival rates were 47.0%and 26.5%,respectively(P=0.003).By Cox regression model multivariate analysis,the results showed that LMR value before radical chemoradiotherapy was an independent factor affecting the prognosis of elderly EC patients(HR=0.634,95%CI:0.422-0.954,P=0.029).Conclusion In elderly EC patients receiving radical chemoradiotherapy,reduced LMR prior to radical chemoradiotherapy was an independent adverse prognostic factor.