不同治疗模式下局部晚期不可切除NSCLC患者血细胞计数临床意义

Clinical significance of blood cell count in locally advanced unresectable NSCLC patients under different treatment modes

目的探讨不同治疗模式血细胞变化规律及放疗过程中血细胞变化与非小细胞肺癌(NSCLC)患者预后的关系。方法选取2018-07-05-2022-08-15山东省肿瘤医院接受治疗的208例局部晚期不可切除NSCLC患者为研究对象。收集临床特征资料和不同治疗模式下中性粒细胞计数、淋巴细胞计数及中性粒细胞与淋巴细胞比值(NLR),计算患者无进展生存期(PFS)。使用Pearson线性相关分析中性粒细胞计数/基线值、淋巴细胞计数/基线值和NLR/基线值与放疗天数相关性。采用Kaplan-Meier法绘制生存曲线。结果73例NSCLC患者放疗前后中性粒细胞计数均值分别为(4.01±2.05)×10^(9)L^(-1)和(2.84±1.76)×10^(9)L^(-1),Z=3.29,P<0.001;放疗前后淋巴细胞计数均值分别为(1.55±0.66)×10^(9)L^(-1)和(1.12±0.52)×10^(9)L^(-1),Z=3.89,P<0.001;放疗后和放疗前NLR均值分别为(4.53±2.37)×10^(9)L^(-1)和(2.95±1.86)×10^(9)L^(-1),Z=3.32,P<0.001。比较接受化疗或免疫治疗前后血细胞计数,治疗前后中性粒细胞(Z=3.72,P<0.001)和淋巴细胞(Z=2.81,P=0.005)差异有统计学意义。接受单独免疫治疗的患者治疗后平均淋巴细胞计数升高约0.19×10^(9)L^(-1),Z=3.36,P<0.001;接受化疗同步免疫治疗的患者淋巴细胞治疗前后均值分别为(1.42±0.50)×10^(9)L^(-1)和(1.25±0.90)×10^(9)L^(-1),Z=3.62,P<0.001。中性粒细胞计数/基线值与放疗持续天数呈负相关,r=-0.480,P=0.013;淋巴细胞计数/基线值与放疗持续天数呈负相关,r=-0.480,P<0.001;NLR值/基线值与放疗持续天数呈正相关,r=0.190,P=0.014。基于淋巴细胞进行分组,高水平患者和低水平患者中位PFS分别为20.1和10.7个月,χ^(2)=4.50,P=0.034;基于中性粒细胞进行分组,高水平患者和低水平患者中位PFS分别为14.1和16.7个月,χ^(2)=0.50,P=0.470;基于NLR进行分组,高水平患者和低水平患者中位PFS分别为13.9和15.3个月,χ^(2)=0.10,P=0.820。结论化疗主要导致中性粒细胞减少,放疗主要导致淋巴细胞减少;淋巴细胞计数/基线值是接受放疗的局部晚期不可切除NSCLC患者PFS的预测指标。

Objective To explore the pattern of blood cell changes in different treatment modalities and the relationship between blood cell changes during radiotherapy and the prognosis of NSCLC patients.Methods A total of 208patients with locally advanced unresectable non-small cell cancer(NSCLC)who received treatment at Shandong Cancer Hospital and Institute from July 5th,2018to August 15th,2022were selected as the study subjects.Clinical characteristic data and neutrophil count,lymphocyte count,and neutrophil to lymphocyte ratio(NLR)under different treatment modes were collected,and the progression-free survival(PFS)of patients was calculated.Pearson linear correlation analysis was used to analyze the correlation between neutrophil count/baseline,lymphocyte count/baseline value,and NLR/baseline value with radiation therapy duration.Kaplan Meier method was used to plot survival curves.Results The mean neutrophil counts of 73NSCLC patients before and after radiotherapy were(4.01±2.05)×10^(9)L^(-1)and(2.84±1.76)×10^(9)L^(-1),respectively,Z=3.29and P<0.001.The mean lymphocyte counts before and after radiotherapy were(1.55±0.66)×10^(9)L^(-1)and(1.12±0.52)×10^(9)L^(-1),respectively,Z=3.89and P<0.001.The mean NLR counts after and before radiotherapy were(4.53±2.37)×10^(9)L^(-1)and(2.95±1.86)×10^(9)L^(-1),respectively,Z=3.32and P<0.001.Comparing the changes in blood cell count before and after chemotherapy or immunotherapy,there was a statistically significant difference in neutrophils(Z=3.72,P<0.001)and lymphocytes(Z=2.81,P=0.005)before and after treatment.After receiving immunotherapy alone,the average lymphocyte count of patients increased by about 0.19×10^(9)L^(-1),Z=3.36,P<0.001;The mean values of lymphocytes in patients receiving synchronous immunotherapy with chemotherapy before and after treatment were(1.42±0.50)×10^(9)L^(-1)and(1.25±0.90)×10^(9)L^(-1),respectively,Z=3.62and P<0.001.The neutrophil count/baseline value was negatively correlated with the duration of radiotherapy,r=-0.480,P=0.013;The lymphocyte count/baseline value was negatively correlated with the duration of radiotherapy,r=-0.480,P<0.001;The NLR was positively correlated with the duration of radiotherapy,r=0.190,P=0.014.Based on lymphocyte grouping,the median PFS of high-level and low-level patients was 20.1and 10.7months,respectively,χ^(2)=4.50,P=0.034;Grouping based on neutrophils grouping,the median PFS of high-level and low-level patients was 14.1and 16.7months,respectively,χ^(2)=0.50,P=0.470;Based on NLR grouping,the median PFS of high-level and low-level patients was 13.9and 15.3months,respectively,χ^(2)=0.10,P=0.820.Conclusion Chemotherapy mainly leads to a decrease in neutrophils,while radiotherapy mainly leads to a decrease in lymphocytes;Lymphocyte count/baseline value is a predictive indicator of PFS in locally advanced unresectable NSCLC patients receiving radiotherapy.