Chang Gung University, Medicine, Taoyuan City, Taiwan.
Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan.
J Geriatr Oncol. 2019 Sep;10(5):757-762. doi: 10.1016/j.jgo.2019.04.015. Epub 2019 May 10.
Treatment options for older patients with malignancies remain suboptimal. An accurate prognostic stratification could inform treatment decisions, which can potentially improve patient outcomes. Here, we sought to investigate whether the neutrophil-to-lymphocyte ratio (NLR) may have prognostic significance in patients with metastatic malignant tumors, with a special focus on older individuals.
We retrospectively reviewed the clinical records of 3981 patients with histology-proven metastatic cancer who underwent radiotherapy between 2000 and 2013. The pretreatment NLR was determined within 7 days before treatment initiation. Patients aged ≥65 years were considered as older. We analyzed the prognostic significance of NLR for overall survival (OS) across all age groups.
Compared with their younger counterparts, older patients showed a higher NLR (P < 0.001) and a lower OS (P < 0.001). Multivariate analysis revealed that a pretreatment NLR below the median was an independent favorable predictor of OS in both older (hazard ratio [HR]: 0.669, 95.0% CI: 0.605-0.740; P < 0.001) and younger patients (HR: 0.704; 95.0% CI: 0.648-0.765; P < 0.001). Regardless of age, patients who underwent systemic therapy showed more favorable OS, especially when NLR was low. In the older subgroup, the OS of patients with a low pretreatment NLR who did not undergo systemic therapy and of those with high pretreatment NLR who underwent systemic therapy was similar.
A low pretreatment NLR predicts a more favorable OS in older patients with metastatic cancer. The most favorable OS was observed in patients with a low pretreatment NLR who received systemic therapy.
对于老年恶性肿瘤患者，治疗选择仍不理想。准确的预后分层可以为治疗决策提供信息，从而有可能改善患者的预后。在这里，我们旨在探讨中性粒细胞与淋巴细胞比值（NLR）是否对转移性恶性肿瘤患者，特别是老年患者具有预后意义。
我们回顾性分析了 2000 年至 2013 年间接受放疗的 3981 例组织学证实的转移性癌症患者的临床记录。在治疗开始前 7 天内确定治疗前 NLR。年龄≥65 岁的患者被视为老年患者。我们分析了 NLR 对所有年龄组患者总生存（OS）的预后意义。
与年轻患者相比，老年患者的 NLR 更高（P<0.001），OS 更低（P<0.001）。多变量分析显示，治疗前 NLR 低于中位数是老年（危险比[HR]：0.669，95.0%CI：0.605-0.740；P<0.001）和年轻患者（HR：0.704；95.0%CI：0.648-0.765；P<0.001）OS 的独立有利预测因素。无论年龄大小，接受全身治疗的患者均具有更好的 OS，尤其是当 NLR 较低时。在老年亚组中，未接受全身治疗的 NLR 低的患者和接受全身治疗的 NLR 高的患者的 OS 相似。
治疗前 NLR 低预示着转移性癌症老年患者的 OS 更有利。接受全身治疗且 NLR 低的患者的 OS 最佳。
