Neal Christopher P, Cairns Vaux, Jones Michael J, Masood Muhammad M, Nana Gael R, Mann Christopher D, Garcea Giuseppe, Dennison Ashley R
Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK,
Med Oncol. 2015 May;32(5):144. doi: 10.1007/s12032-015-0590-2. Epub 2015 Mar 26.
A range of prognostic cellular indices of the systemic inflammatory response, namely the neutrophil-lymphocyte ratio (NLR), derived NLR (dNLR), platelet-lymphocyte ratio (PLR), lymphocyte-monocyte ratio (LMR), combination of platelet count and neutrophil-lymphocyte ratio (COP-NLR) and prognostic nutritional index (PNI), have been developed and found to have prognostic utility across varied malignancies. The current study is the first to examine the prognostic value of these six inflammatory scores in patients with resectable colorectal liver metastases (CRLM). Data from 302 consecutive patients undergoing surgery for resectable CRLM were evaluated. The prognostic influence of clinicopathological variables and the inflammatory scores NLR, dNLR, PLR, LMR, COP-NLR and PNI upon overall survival (OS) and cancer-specific survival (CSS) were determined by log-rank analysis and univariate and multivariate Cox regression analyses. High preoperative NLR was the only inflammatory variable independently associated with shortened OS (HR 1.769, 95 % CI 1.302-2.403, P < 0.001) or CSS (HR 1.927, 95 % CI 1.398-2.655, P < 0.001) following metastasectomy. When NLR was replaced by dNLR in analyses, high dNLR was independently associated with shortened OS (HR 1.932, 95 % CI 1.356-2.754, P < 0.001) and CSS (HR 1.807, 95 % CI 1.209-2.702, P = 0.004). The inflammatory scores PLR, LMR, COP-NLR and PNI demonstrated no independent association with either overall or cancer-specific survival in the study population. Our findings support high preoperative NLR and dNLR as independent prognostic factors for poor outcome in patients undergoing CRLM resection, with prognostic value superior to other cellular-based systemic inflammatory scores.
一系列全身性炎症反应的预后细胞指标，即中性粒细胞与淋巴细胞比值（NLR）、衍生NLR（dNLR）、血小板与淋巴细胞比值（PLR）、淋巴细胞与单核细胞比值（LMR）、血小板计数与中性粒细胞与淋巴细胞比值的组合（COP-NLR）以及预后营养指数（PNI），已经被开发出来，并发现它们在各种恶性肿瘤中都具有预后价值。本研究首次探讨了这六种炎症评分在可切除结直肠癌肝转移（CRLM）患者中的预后价值。评估了302例连续接受可切除CRLM手术患者的数据。通过对数秩分析以及单因素和多因素Cox回归分析，确定了临床病理变量以及炎症评分NLR、dNLR、PLR、LMR、COP-NLR和PNI对总生存期（OS）和癌症特异性生存期（CSS）的预后影响。术前高NLR是转移灶切除术后与OS缩短（HR 1.769，95%CI 1.302 - 2.403，P < 0.001）或CSS缩短（HR 1.927，95%CI 1.398 - 2.655，P < 0.001）独立相关的唯一炎症变量。在分析中用dNLR替代NLR时，高dNLR与OS缩短（HR 1.932，95%CI 1.356 - 2.754，P < 0.001）和CSS缩短（HR 1.807，95%CI 1.209 - 2.702，P = 0.004）独立相关。炎症评分PLR、LMR、COP-NLR和PNI在研究人群中与总生存期或癌症特异性生存期均无独立相关性。我们的研究结果支持术前高NLR和dNLR作为CRLM切除患者预后不良的独立预后因素，其预后价值优于其他基于细胞的全身性炎症评分。
