Department of Surgery, Azienda ULSS2 Marca Trevigiana, 31100, Treviso, Italy.
General Surgery Unit, Azienda Ospedaliera di Padova, 35128, Padua, Italy.
Int J Colorectal Dis. 2019 Nov;34(11):1849-1856. doi: 10.1007/s00384-019-03356-5. Epub 2019 Sep 13.
Several studies demonstrated the prognostic value of the neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and platelet-to-white blood cells ratio (PWR) in different types of tumors. However, there is no information about a possible role of NLR, PLR and PWR as predictor of presence of metastasis or multifocal disease in patients undergoing surgery with curative intent for midgut NET. The aim of our study was to test the role of preoperative NLR, PLR and PWR as predictors of patients undergoing surgery with curative intent for midgut NET.
We retrospectively enrolled seven foregut, 35 midgut and six hindgut NET patients with gastrointestinal neuroendocrine tumors operated in our Units from January 2005 to June 2016. Details about preoperative laboratory data, surgical operation, histology and follow-up were retrieved. Non-parametric statistics, ROC curve analysis and survival analysis were used.
NLR was significantly higher in patients with distant metastasis (p = 0.04). The ROC curve analysis indicated that a threshold value of NLR of 2.6 predicted the presence of peritoneal metastasis with a specificity of 100% and a sensitivity of 71% and an overall accuracy of AUC = 0.81 (95%CI: 0.59-0.94), p = 0.05. PLR and PWR was not be associated to metastasis but tended to be associated to multifocal disease.
In patients with midgut NET, an impaired adaptive immune response, as suggested by a high NLR ratio, was associated to the presence of distant metastasis and in particular of peritoneal metastasis. This information may be helpful when planning the treatment of a patient with a midgut NET.
多项研究表明中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）和血小板与白细胞比值（PWR）在不同类型肿瘤中的预后价值。然而，对于接受根治性手术治疗的中肠神经内分泌肿瘤（NET）患者，NLR、PLR 和 PWR 是否可能作为转移或多灶性疾病存在的预测指标，尚无相关信息。本研究旨在探讨术前 NLR、PLR 和 PWR 作为接受根治性手术治疗的中肠 NET 患者的预测指标的作用。
我们回顾性纳入了 2005 年 1 月至 2016 年 6 月在我们医院接受手术治疗的 7 例前肠、35 例中肠和 6 例后肠 NET 患者。检索了术前实验室数据、手术操作、组织学和随访等详细信息。采用非参数统计、ROC 曲线分析和生存分析。
远处转移患者的 NLR 显著升高（p=0.04）。ROC 曲线分析表明，NLR 阈值为 2.6 预测腹膜转移的特异性为 100%，敏感性为 71%，总准确性 AUC=0.81（95%CI：0.59-0.94），p=0.05。PLR 和 PWR 与转移无关，但与多灶性疾病有关。
在中肠 NET 患者中，适应性免疫反应受损，如 NLR 比值升高提示存在远处转移，尤其是腹膜转移。这些信息可能有助于规划中肠 NET 患者的治疗。
