血小板与淋巴细胞比值和乳酸脱氢酶与卡瑞利珠单抗治疗的晚期食管鳞癌患者预后的相关性研究

Correlation of platelet-lymphocyte ratio and lactate dehydrogenase in the prognosis of patients with advanced esophageal squamous cell carcinoma receiving immunotherapy with camrelizumab

目的探究中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)、全身免疫炎症指数(SII)、乳酸脱氢酶(LDH)指标与接受卡瑞利珠单抗免疫治疗的晚期食管鳞癌患者预后的相关性。方法本研究为回顾性队列研究,选取2020年7月至2022年6月在连云港市第二人民医院肿瘤科收治的64例食管鳞癌患者,男12例,女52例,年龄68(63,74)岁,年龄范围为52~85岁。收集患者的一般资料和治疗前1周的外周血液指标,通过受试者操作特征曲线确定最佳截断值,采用Kaplan-Meier法进行生存分析,采用Cox比例风险模型对无进展生存期和总生存期分别进行单因素和多因素分析预后因素。结果NLR的曲线下面积为0.841,最佳截断值为4.6;PLR的曲线下面积为0.842,最佳截断值为194.5;SII的曲线下面积为0.792,最佳截断值是725.4;LDH的曲线下面积为0.731,最佳截断值为277.0 U/L。在Cox单因素分析中,LDH、NLR、SII与无进展生存期相关(P<0.05),多因素分析结果提示LDH与无进展生存期独立相关(P<0.05)。在Cox单因素分析中,肿瘤分期、LDH、NLR、PLR、SII与总生存期相关(P<0.05),多因素分析结果提示肿瘤分期、LDH、PLR与总生存期独立相关(P<0.05)。生存曲线分析显示,LDH≤277.0 U/L比LDH>277.0 U/L有较长的无进展生存期,LDH≤277.0 U/L比LDH>277.0 U/L有较长的总生存期,PLR≤194.5比PLR>194.5有较长的总生存期。联合指标的曲线下面积(0.876)高于单一LDH曲线下面积(0.713)和单一PLR曲线下面积(0.842),表明LDH联合PLR的预测价值更高。结论LDH、PLR对晚期食管鳞癌患者接受卡瑞利珠单抗治疗预后有关,并且LDH联合PLR的预测价值高于单一指标,NLR、SII并未发现与预后有一定相关性。

Objective To investigate the correlation of neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR),systemic immune-inflammation index(SII),lactate dehydrogenase(LDH)and prognosis of patients with advanced esophageal squamous cell carcinoma receiving immunotherapy with the camrelizumab.Methods This study was a retrospective cohort study,a total of 64 patients with advanced esophageal squamous cell carcinoma admitted to the department of Oncology in the Second People′s Hospital of Lianyungang from July 2020 to June 2022,including 12 males and 52 females,aged 68(63,74)years old,age ranging from 52 to 85 years old.The general data of the patients and peripheral blood indexes 1 week before treatment were collected,the optimal cut-off value was determined by the receiver operator characteristic curve,the Kaplan-Meier method was used for survival analysis,and the Cox proportional risk model was used to analyze prognostic factors by univariate and multivariate analyses for progression-free survival and overall survival respectively.Results The area under the curve of NLR was 0.841,with an optimal cut-off value of 4.6;the area under the curve of PLR was 0.842,with an optimal cut-off value of 194.5;the area under the curve of SII was 0.792,with an optimal cut-off value of 725.4;and the area under the curve of LDH was 0.731,with an optimal cut-off value of 277.0 U/L.In the Cox univariate analysis,LDH,NLR,SII were associated with progression-free survival(P<0.05),and the results of multifactorial analysis suggested that LDH was independently associated with progression-free survival(P<0.05).In Cox univariate analysis,tumor stage,LDH,NLR,PLR,and SII were associated with overall survival(P<0.05),and the results of multifactorial analysis suggested that tumor stage,LDH,and PLR were independently associated with overall survival(P<0.05).Survival curve analysis showed that LDH≤277.0 U/L had a longer progression-free survival than LDH>277.0 U/L,LDH≤277.0 U/L had a longer overall survival than LDH>277.0 U/L,and PLR≤194.5 had a longer overall survival than PLR>194.5.The area under the curve of the combined index(0.876)was higher than the area under the curve of single LDH(0.713)and the area under the curve of single PLR(0.842),suggested that the predictive value of LDH combined with PLR was higher.Conclusions LDH and PLR were associated with prognosis in patients with advanced esophageal squamous cell carcinoma receiving immunotherapy with the camrelizumab,and the predictive value of LDH combined with PLR was higher than that of a single indicator,NLR and SII were not found to be associated with a certain prognosis.