Department of Thoracic Surgery, University of Tsukuba, 1-1-1 Tennoudai Tsukuba 305-8575, Japan.
Lung Cancer. 2012 Feb;75(2):223-7. doi: 10.1016/j.lungcan.2011.06.009. Epub 2011 Jul 20.
A number of prognostic factors have been reported in non-small cell lung cancer (NSCLC). Although lymph node metastasis is the most poorly predictive value in completely resected NSCLC, a significant number of patients have a fatal recurrence even in node-negative curative NSCLC. Recently inflammatory response has been shown as a predictive value in NSCLC. Neutrophils and lymphocytes play an important role in cancer immune response. In this study, we retrospectively examined the impact of preoperative peripheral neutrophil and lymphocyte counts on survival, and investigated the relationships of these factors to clinicopathological factors in node-negative NSCLC. A total 237 patients were evaluated. When the cut-off value of neutrophil count was 4500 mm(-3) with a maximum log-rank statistical value, overall 5-year survival rates were 79.7% for the low-neutrophil-count group and 69.5% for the high-neutrophil-count group (P=0.04). When the cut-off value of lymphocyte count was 1900 mm(-3) with a maximum log-rank statistical value, overall survival rates were 67.9% for the low-lymphocyte group and 87.7% for the high-lymphocyte group (P<0.001). High-neutrophil-counts were associated with tumor size (P=0.002) and pleural invasion (P<0.001). Low-lymphocyte-counts were correlated with vascular invasion (P=0.018) and recurrence of NSCLC (P=0.01). Multivariate analysis showed that the lymphocyte count was an independent prognostic factor (hazard ratio: 3.842; 95% confidence interval: 1.827-8.078; P<0.001), but the neutrophil count was not (P=0.185). We conclude that a peripheral lymphocyte count, which is associated with vascular invasion, is an independent prognostic factor in node-negative NCSLC.
许多预后因素已在非小细胞肺癌（NSCLC）中被报道。虽然淋巴结转移是完全切除 NSCLC 中预测价值最差的因素，但即使在淋巴结阴性的可治愈 NSCLC 中，仍有相当数量的患者发生致命复发。最近，炎症反应已被证明在 NSCLC 中具有预测价值。中性粒细胞和淋巴细胞在癌症免疫反应中发挥重要作用。在这项研究中，我们回顾性地检查了术前外周血中性粒细胞和淋巴细胞计数对生存的影响，并研究了这些因素与淋巴结阴性 NSCLC 的临床病理因素的关系。共评估了 237 例患者。当以最大对数秩统计值为 4500mm(-3)时，中性粒细胞计数的截断值为 4500mm(-3)，低中性粒细胞计数组的总 5 年生存率为 79.7%，高中性粒细胞计数组为 69.5%（P=0.04）。当以最大对数秩统计值为 1900mm(-3)时，淋巴细胞计数的截断值为 1900mm(-3)，低淋巴细胞组的总生存率为 67.9%，高淋巴细胞组为 87.7%（P<0.001）。高中性粒细胞计数与肿瘤大小（P=0.002）和胸膜侵犯（P<0.001）相关。低淋巴细胞计数与血管侵犯（P=0.018）和 NSCLC 复发（P=0.01）相关。多变量分析显示，淋巴细胞计数是独立的预后因素（危险比：3.842；95%置信区间：1.827-8.078；P<0.001），而中性粒细胞计数不是（P=0.185）。我们的结论是，与血管侵犯相关的外周血淋巴细胞计数是淋巴结阴性 NSCLC 的独立预后因素。
