术前中性粒细胞与淋巴细胞比值、血小板与淋巴细胞比值和单核细胞与淋巴细胞比值的联合：子宫内膜癌的一个优越预后因素。
Combination of preoperative neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and monocyte-lymphocyte ratio: a superior prognostic factor of endometrial cancer.
机构信息
Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Sanhao Street, 110004, Shenyang, People's Republic of China.
Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China.
出版信息
BMC Cancer. 2020 May 24;20(1):464. doi: 10.1186/s12885-020-06953-8.
BACKGROUND
The preoperative peripheral blood neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and monocyte-lymphocyte ratio (MLR) have been reported to be associated with the prognosis of various cancers but are always discussed separately. The aim of this study is to bring the combination of NLR, PLR and MLR into the prognostic assessment system of endometrial cancer (EC) and establish a nomogram to provide an objective prediction model for clinical decisions.
METHODS
A total of 1111 patients with EC who had accepted surgical treatment during 2013-2017 were involved in the analysis. Their NLR, PLR, and MLR levels were obtained from a routine blood examination within 2 weeks before operation. Receiver operating characteristic curve (ROC) analysis was performed to determine optimal cutoffs. Chi-square tests analysed the associations of the ratios with other clinicopathological variables. The prognostic value was indicated by overall survival (OS) via Cox proportional hazards models and Kaplan-Meier analysis. R software was used to establish the nomogram based on the combination of NLR, PLR, MLR and other clinicopathological factors.
RESULTS
The median follow-up period was 40 months, and the median age was 56. The enrolled patients were stratified by cutoffs of 2.14 for NLR, 131.82 for PLR and 0.22 for MLR. Multivariate analyses demonstrated that high NLR over 2.14 (HR = 2.71, 95%CI = 1.83-4.02, P<0.001), high PLR over 131.82 (HR = 2.75, 95%CI = 1.90-3.97, P<0.001), and high MLR over 0.22 (HR = 1.72, 95%CI = 1.20-2.45, P = 0.003) were significantly associated with worse OS. The combined indicator, high NLR + high PLR + high MLR (HR = 4.34, 95%CI = 2.54-7.42, P<0.001), showed the highest prognostic value. The Harrell's concordance index of the nomogram was 0.847 (95% CI = 0.804-0.890), showing good discrimination and calibration of this model.
CONCLUSION
The combination of NLR, PLR, and MLR is a superior prognostic factor of EC. The nomogram involving the combination of NLR, PLR, MLR and other clinicopathological factors is recommended to predict OS for EC patients clinically.
背景
术前外周血中性粒细胞-淋巴细胞比值（NLR）、血小板-淋巴细胞比值（PLR）和单核细胞-淋巴细胞比值（MLR）已被报道与各种癌症的预后相关，但通常分别讨论。本研究的目的是将 NLR、PLR 和 MLR 结合到子宫内膜癌（EC）的预后评估系统中，并建立一个列线图，为临床决策提供客观的预测模型。
方法
分析了 2013-2017 年期间接受手术治疗的 1111 例 EC 患者。在手术前 2 周内通过常规血液检查获得他们的 NLR、PLR 和 MLR 水平。通过接受者操作特征曲线（ROC）分析确定最佳截断值。卡方检验分析了比值与其他临床病理变量的相关性。通过 Cox 比例风险模型和 Kaplan-Meier 分析，通过总生存（OS）表示预后价值。基于 NLR、PLR、MLR 以及其他临床病理因素的组合，使用 R 软件建立列线图。
结果
中位随访时间为 40 个月，中位年龄为 56 岁。根据 NLR 的截断值 2.14、PLR 的截断值 131.82 和 MLR 的截断值 0.22 将入组患者分层。多变量分析表明，NLR 高于 2.14（HR=2.71，95%CI=1.83-4.02，P<0.001）、PLR 高于 131.82（HR=2.75，95%CI=1.90-3.97，P<0.001）和 MLR 高于 0.22（HR=1.72，95%CI=1.20-2.45，P=0.003）与较差的 OS 显著相关。高 NLR+高 PLR+高 MLR（HR=4.34，95%CI=2.54-7.42，P<0.001）的联合指标显示出最高的预后价值。列线图的 Harrell 一致性指数为 0.847（95%CI=0.804-0.890），表明该模型具有良好的区分度和校准度。
结论
NLR、PLR 和 MLR 的组合是 EC 的一个较好的预后因素。建议使用包含 NLR、PLR、MLR 以及其他临床病理因素的列线图来预测 EC 患者的 OS。
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