中性粒细胞与淋巴细胞比值对结直肠癌肺转移切除术的预后价值。

Prognostic value of neutrophil to lymphocyte ratio in lung metastasectomy for colorectal cancer.

机构信息

Department of Thoracic Surgery, Nancy University Hospital, Nancy, France.

Department of Thoracic and Upper Gastrointestinal Surgery, McGill University Health Centre, Montreal, QC, Canada.

出版信息

Eur J Cardiothorac Surg. 2019 May 1;55(5):948-955. doi: 10.1093/ejcts/ezy388.

DOI:10.1093/ejcts/ezy388

PMID:30508167

Abstract

OBJECTIVES

Neutrophil to lymphocyte ratio (NLR) has been shown to be a promising biomarker in several cancers. Prognostic biomarkers are still needed to define good candidates for lung metastasectomy for colorectal cancer. We aimed to evaluate the role of NLR.

METHODS

Data from 574 patients who underwent lung metastasectomy for colorectal cancer in 3 departments of thoracic surgery from 2004 to 2014 were retrospectively reviewed. Overall survival (OS) and the time to pulmonary recurrence (TTPR) were the main end points.

RESULTS

Correlations between NLR and OS (R2 = 0.53), and NLR and TTPR (R2 = 0.389) were significant (P < 0.0001 for both), with corresponding Pearson R of -0.728 (P < 0.0001) and -0.624 (P < 0.0001), respectively. A receiver operating characteristic curve analysis highlighted an NLR cut-off value of 4.05 as the best predictor of OS and TTPR. NLR ≤4.05 was observed in 238 patients (41.4%). In the univariable analysis, the median OS was 117 months for patients with NLR ≤4.05 and decreased to 40 months for patients with NLR >4.05 (P < 0.0001). The median TTPR reached 52 months in case of NLR ≤4.05 and decreased to 12 months in patients with NLR >4.05. In the multivariable analysis, NLR ≤4.05 remained an independent favourable prognostic factor on both OS [hazard ratio [HR] 0.29, 95% confidence interval (CI) 0.167-0.503; P < 0.0001] and TTPR (HR 0.346, 95% CI 0.221-0.54; P < 0.0001). Significant correlations between NLR >4.05 and KRAS (Cramer's V = 0.241, P < 0.0001) and BRAF (Cramer's V = 0.153, P = 0.003) mutations were observed.

CONCLUSIONS

NLR is a simple and powerful predictor of outcomes in patients undergoing pulmonary metastasectomy for colorectal cancer.

摘要

目的

中性粒细胞与淋巴细胞比值（NLR）已被证明是多种癌症中有前途的生物标志物。仍然需要预后生物标志物来定义结直肠癌肺转移切除术的合适候选者。我们旨在评估 NLR 的作用。

方法

回顾性分析了 2004 年至 2014 年期间在 3 个胸外科部门接受结直肠癌肺转移切除术的 574 名患者的数据。总生存期（OS）和肺复发时间（TTPR）是主要终点。

结果

NLR 与 OS（R2=0.53）和 NLR 与 TTPR（R2=0.389）之间存在显著相关性（均 P<0.0001），相应的 Pearson R 值分别为-0.728（P<0.0001）和-0.624（P<0.0001）。ROC 曲线分析显示 NLR 截断值为 4.05 是 OS 和 TTPR 的最佳预测指标。238 例患者 NLR≤4.05（41.4%）。在单变量分析中，NLR≤4.05 的患者中位 OS 为 117 个月，而 NLR>4.05 的患者中位 OS 降至 40 个月（P<0.0001）。NLR≤4.05 的患者中位 TTPR 为 52 个月，而 NLR>4.05 的患者中位 TTPR 降至 12 个月。在多变量分析中，NLR≤4.05 仍然是 OS（风险比[HR]0.29，95%置信区间[CI]0.167-0.503；P<0.0001）和 TTPR（HR 0.346，95%CI 0.221-0.54；P<0.0001）的独立有利预后因素。NLR>4.05 与 KRAS（Cramer's V=0.241，P<0.0001）和 BRAF（Cramer's V=0.153，P=0.003）突变之间存在显著相关性。