Shi Minxing, Zhao Wencheng, Zhou Fei, Chen Hao, Tang Liang, Su Bo, Zhang Jie
Department of Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China.
Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China.
Transl Lung Cancer Res. 2020 Feb;9(1):45-54. doi: 10.21037/tlcr.2020.01.17.
Pulmonary large cell neuroendocrine carcinoma (LCNEC) is a rare clinical subtype of lung cancer which has a poor prognosis for patients. This study aimed to explore the relationship between blood-based inflammatory markers, namely neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), and the prognosis for pulmonary LCNEC.
Peripheral leukocyte and platelet counts of 106 LCNEC patients were measured within the week leading up to their surgery. Serum neuron specific enolase (NSE) was detected by ELISA. Overall survival (OS) was analyzed by Kaplan-Meier method and compared by log-rank test.
The NLR and PLR cut-off values based on survival receiver operating characteristic curve (ROC) were 2.52 and 133.6, respectively. A correlation was found between dichotomized NLR and tumor size (P=0.006), and PLR and NLR were significantly correlated with each other (P<0.001). Patients with high NLR or PLR had shorter survival than those with low NLR (HR =2.46, 95% CI: 1.508-4.011, P<0.001) or PLR (HR =2.086, 95% CI: 1.279-3.402, P=0.003). Serum NSE also had a significant effect on patient survival (HR =2.651, 95% CI: 1.358-5.178, P=0.004). The effects of peripheral blood lymphocytes (P=0.001), neutrophils (P=0.023) and platelets (P=0.051) on patient survival were compared by log-rank test. In multivariate survival analysis, NLR (P<0.001) and T category were vital for the prognoses of LCNEC patients.
The inflammatory or immunological markers, NLR and PLR in blood, were independent factors of survival prediction for patients with LCNEC, which implied that cellular immunity was involved in the progression of LCNEC. Peripheral blood lymphocytes and neutrophils have a fundamental effect on survival. Whether or not NLR and PLR can be useful biomarkers in efficacy prediction of immunotherapy in LCNEC calls for further investigation.
肺大细胞神经内分泌癌（LCNEC）是肺癌中一种罕见的临床亚型，患者预后较差。本研究旨在探讨血液炎症标志物，即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）与肺LCNEC患者预后之间的关系。
对106例LCNEC患者在手术前一周内测量外周血白细胞和血小板计数。采用酶联免疫吸附测定法检测血清神经元特异性烯醇化酶（NSE）。采用Kaplan-Meier法分析总生存期（OS），并通过对数秩检验进行比较。
基于生存曲线下面积（ROC）的NLR和PLR临界值分别为2.52和133.6。二分法NLR与肿瘤大小之间存在相关性（P = 0.006），PLR与NLR之间存在显著相关性（P < 0.001）。NLR或PLR高的患者生存期短于NLR低（HR = 2.46，95%CI：1.508 - 4.011，P < 0.001）或PLR低的患者（HR = 2.086，95%CI：1.279 - 3.402，P = 0.003）。血清NSE对患者生存期也有显著影响（HR = 2.651，95%CI：1.358 - 5.178，P = 0.004）。通过对数秩检验比较外周血淋巴细胞（P = 0.001）、中性粒细胞（P = 0.023）和血小板（P = 0.051）对患者生存期的影响。在多因素生存分析中，NLR（P < 0.001）和T分期对LCNEC患者的预后至关重要。
血液中的炎症或免疫标志物NLR和PLR是LCNEC患者生存预测的独立因素，这意味着细胞免疫参与了LCNEC的进展。外周血淋巴细胞和中性粒细胞对生存期有重要影响。NLR和PLR是否可作为LCNEC免疫治疗疗效预测的有用生物标志物有待进一步研究。
