Hu Jia, Chen Dongni, Wu Shaoyong, Chen Youfang, Li Rongzhen, Miao Huikai, Wen Zhesheng
Department of Thoracic Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.
J Thorac Dis. 2020 Mar;12(3):363-374. doi: 10.21037/jtd.2020.01.31.
It is widely accepted that the pretreatment neutrophil-to-lymphocyte ratio (NLR) is an independent predictor of prognosis in multiple malignancies, including esophageal squamous cell carcinoma (ESCC). However, its predictive value in middle thoracic esophageal carcinoma is still unclear. Therefore, the purpose of this study was to investigate the preoperative serum levels of NLR in middle thoracic esophageal carcinoma patients to clarify their clinical significance as predictors of prognosis.
This study investigated 556 patients with middle thoracic ESCC treated by esophagectomy from January 2010 to December 2012. The prognostic impact of serum NLR level was analyzed. A receiver operating characteristic (ROC) curve was used to identify the NLR for predicting survival. Correlation between the NLR and clinicopathological characteristics was analyzed by χ test. Prognostic influence was calculated by using the Kaplan-Meier method and the difference was compared by log-rank test. Cox regression analysis was performed to evaluate the significant prognostic factors.
The cutoff value for the NLR was 2.43 ng/mL, the area under the curve was 0.553 (95% CI: 0.504-0.601; P=0.035), and the sensitivity and specificity were 53.3% and 58.7% respectively. It is demonstrated that preoperative NLR (P=0.003), T stage (P<0.001), N stage (P<0.001), surgical approach (P=0.004), and gender (P=0.008) were independent prognostic factors in middle thoracic ESCC by univariate analysis. Multivariate analysis showed that preoperative NLR (P=0.036), T stage (P=0.004), N stage (P<0.001), surgical approach (P=0.002), and age (P=0.019) were independent prognostic factors for survival.
Pretreatment NLR >2.43 ng/mL could serve as an indicator of poor prognosis in middle thoracic ESCC patients after surgical treatment.
人们普遍认为，术前中性粒细胞与淋巴细胞比值（NLR）是包括食管鳞状细胞癌（ESCC）在内的多种恶性肿瘤预后的独立预测指标。然而，其在胸段中段食管癌中的预测价值仍不明确。因此，本研究旨在调查胸段中段食管癌患者术前血清NLR水平，以阐明其作为预后预测指标的临床意义。
本研究调查了2010年1月至2012年12月期间接受食管切除术治疗的556例胸段中段ESCC患者。分析血清NLR水平对预后的影响。采用受试者工作特征（ROC）曲线确定预测生存的NLR。通过χ检验分析NLR与临床病理特征之间的相关性。采用Kaplan-Meier法计算预后影响，并通过对数秩检验比较差异。进行Cox回归分析以评估显著的预后因素。
NLR的截断值为2.43 ng/mL，曲线下面积为0.553（95%CI：0.504-0.601；P=0.035），敏感性和特异性分别为53.3%和58.7%。单因素分析表明，术前NLR（P=0.003）、T分期（P<0.001）、N分期（P<0.001）、手术方式（P=0.004）和性别（P=0.008）是胸段中段ESCC的独立预后因素。多因素分析表明，术前NLR（P=0.036）、T分期（P=0.004）、N分期（P<0.001）、手术方式（P=0.002）和年龄（P=0.019）是生存的独立预后因素。
术前NLR>2.43 ng/mL可作为胸段中段ESCC患者手术治疗后预后不良的指标。
