Ye Jing, Liao Bing, Jiang Xiaohua, Dong Zhihuai, Hu Sunhong, Liu Yuehui, Xiao Mang
Department of Otolaryngology Head and Neck Surgery, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China.
Department of Otorhinolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China.
Cancer Manag Res. 2020 Jan 31;12:731-741. doi: 10.2147/CMAR.S234618. eCollection 2020.
Peripheral blood inflammation factor neutrophil-lymphocyte ratio (NLR), platelet count (PLT) and nutritional factor serum albumin (ALB) have been proposed as prognostic markers of head and neck squamous carcinoma cancer (HNSCC) in recent years. In the current study, nomogram predict models based on pre-treatment hematological parameters and a modified risk-stratified score system have been built.
A total of 197 patients with oropharyngeal, hypopharyngeal and laryngeal cancers receiving multimodality treatment between 2012 and 2014 were included. The pre-treatment ALB, neutrophil, lymphocyte and platelet count (PLT) were detected. Cancer-specific survival and locoregional recurrence (LRC) by 5 years' follow-up in the cases were obtained. To integrate clinical characteristics, we propose a modified risk-stratified score system. Kaplan-Meier method, proportional hazards COX model, logistic models were used to establish nomograms within external validation.
Five-year LRC was decreased (p=0.004) for 140 patients with pre-treatment NLR <2.77. Five-year LRC and 5-year cancer-specific survival were decreased (p=0.031, p=0.021) with pre-treatment PLT ≥248×10/L. Comparison of univariate parametric models demonstrated that pre-treatment NLR evaluation and PLT>248×10/L were better among tested models. On Bayesian information criteria (BIC) analysis, the optimal prognostic model was then used to develop nomograms predicting 3- and 5-year LRC. The external validation of this predictive model was confirmed in 57 patients from another hospital.
Pre-treatment NLR elevation and PLT>248×10/L are promising predictors of prognosis in patients with operable HNSCC. Nomograms based on the pre-treatment hematological markers and modified risk-stratified score system provide distinct risk stratifications. There results provided the feasibility of anti-inflammatory and antiplatelet treatments for HNSCC patients.
近年来，外周血炎症因子中性粒细胞与淋巴细胞比值（NLR）、血小板计数（PLT）及营养因子血清白蛋白（ALB）被认为是头颈部鳞状细胞癌（HNSCC）的预后标志物。在本研究中，构建了基于治疗前血液学参数的列线图预测模型及改良的风险分层评分系统。
纳入2012年至2014年间接受多模式治疗的197例口咽癌、下咽癌和喉癌患者。检测治疗前的ALB、中性粒细胞、淋巴细胞及血小板计数（PLT）。通过对病例进行5年随访，获得癌症特异性生存率和局部区域复发（LRC）情况。为整合临床特征，我们提出了一种改良的风险分层评分系统。采用Kaplan-Meier法、比例风险COX模型、逻辑模型在外部验证中建立列线图。
140例治疗前NLR<2.77的患者5年LRC降低（p=0.004）。治疗前PLT≥248×10⁹/L时，5年LRC及5年癌症特异性生存率降低（p=0.031，p=0.021）。单变量参数模型比较显示，治疗前NLR评估及PLT>248×10⁹/L在测试模型中表现更佳。经贝叶斯信息准则（BIC）分析，随后使用最佳预后模型开发预测3年和5年LRC的列线图。该预测模型在另一家医院的57例患者中得到外部验证。
治疗前NLR升高及PLT >248×10⁹/L是可手术HNSCC患者预后的有前景的预测指标。基于治疗前血液学标志物和改良风险分层评分系统的列线图提供了不同的风险分层。这些结果为HNSCC患者进行抗炎和抗血小板治疗提供了可行性依据。
