术前中性粒细胞与淋巴细胞比值及血小板与淋巴细胞比值对Ⅰ-Ⅱ期胃癌患者生存的预测作用
Preoperative neutrophil-to-lymphocyte ratio plus platelet-to-lymphocyte ratio in predicting survival for patients with stage I-II gastric cancer.
作者信息
Sun Xiaowei, Liu Xuechao, Liu Jianjun, Chen Shangxiang, Xu Dazhi, Li Wei, Zhan Youqing, Li Yuanfang, Chen Yingbo, Zhou Zhiwei
机构信息
Department of Gastric and Pancreatic Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, P.R. China.
出版信息
Chin J Cancer. 2016 Jun 24;35(1):57. doi: 10.1186/s40880-016-0122-2.
BACKGROUND
The preoperative neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) are associated with poor prognosis of gastric cancer. We aimed to determine whether the combination of NLR and PLR (NLR-PLR) could better predict survival of patients after curative resection for stage I-II gastric cancer.
METHODS
We collected data from the medical records of patients with stage I-II gastric cancer undergoing curative resection between December 2000 and November 2012 at the Sun Yat-sen Cancer Center. The preoperative NLR-PLR was calculated as follows: patients with both elevated NLR (≥2.1) and PLR (≥120) were given a score of 2, and patients with only one or neither were given a score of 1 or 0, respectively.
RESULTS
Kaplan-Meier analysis and log-rank tests revealed significant differences in overall survival (OS) among patients with NLR-PLR scores of 0, 1 and 2 (P < 0.001). Multivariate analysis showed that OS was independently associated with the NLR-PLR score [hazard ratio (HR) = 1.51, 95% confidence interval (CI) 1.02-2.24, P = 0.039] and TNM stage (HR = 1.36, 95% CI 1.01-1.83, P = 0.041). However, other systemic inflammation-based prognostic scores, including the modified Glasgow prognostic score, the prognostic nutritional index, and the combination of platelet count and NLR, were not. In TNM stage-stratified analysis, the prognostic significance of NLR-PLR was maintained in patients with stage I (P < 0.001) and stage II cancers (P = 0.022). In addition, the area under the receiver operating characteristic curve for the NLR-PLR score was higher than those of other systemic inflammation-based prognostic scores (P = 0.001).
CONCLUSION
The preoperative NLR-PLR score is a useful predictor of postoperative survival in the patients with stage I-II gastric cancer and may help identify high-risk patients for rational therapy and timely follow-up.
背景
术前中性粒细胞与淋巴细胞比值（NLR）和血小板与淋巴细胞比值（PLR）与胃癌预后不良相关。我们旨在确定NLR与PLR的联合指标（NLR-PLR）是否能更好地预测Ⅰ-Ⅱ期胃癌根治性切除术后患者的生存情况。
方法
我们收集了2000年12月至2012年11月在中山大学肿瘤防治中心接受根治性切除的Ⅰ-Ⅱ期胃癌患者的病历资料。术前NLR-PLR计算方法如下：NLR（≥2.1）和PLR（≥120）均升高的患者得分为2，仅一项升高或两项均未升高的患者分别得分为1或0。
结果
Kaplan-Meier分析和对数秩检验显示，NLR-PLR评分为0、1和2的患者总生存期（OS）存在显著差异（P<0.001）。多因素分析表明，OS与NLR-PLR评分[风险比（HR）=1.51，95%置信区间（CI）1.02-2.24，P=0.039]和TNM分期（HR=1.36，95%CI 1.01-1.83，P=0.041）独立相关。然而，其他基于全身炎症的预后评分，包括改良格拉斯哥预后评分、预后营养指数以及血小板计数与NLR的联合指标，并不具有相关性。在TNM分期分层分析中，NLR-PLR在Ⅰ期（P<0.001）和Ⅱ期癌症患者（P=0.022）中均保持预后意义。此外，NLR-PLR评分的受试者工作特征曲线下面积高于其他基于全身炎症的预后评分（P=0.001）。
结论
术前NLR-PLR评分是Ⅰ-Ⅱ期胃癌患者术后生存的有用预测指标，可能有助于识别高危患者，以便进行合理治疗和及时随访。
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