Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, Fujian, China.
Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fujian, China.
Oral Dis. 2022 Apr;28(3):631-638. doi: 10.1111/odi.13774. Epub 2021 Jan 28.
To explore the prognostic value of systemic inflammatory biomarkers (albumin/globulin ratio [AGR], neutrophil/lymphocyte ratio [NLR], and platelet/lymphocyte ratio [PLR]) in patients with oral squamous cell carcinoma (OSCC), and further develop a novel prognostic score (AGR-NLR).
A large-scale prospective study enrolling 792 eligible patients from December 2002 to June 2018 was carried out at the First Affiliated Hospital of Fujian Medical University. Three multivariate Cox regression models were performed to assess the association of overall survival (OS) with systemic inflammatory biomarkers, quantified by Akaike information criterion (AIC). Then, a novel AGR-NLR score was established and incorporated into a prognostic nomogram.
In the univariate analysis, the increased AGR was associated with a reduced risk of death. Conversely, the higher NLR and PLR, the worse the OS. In the multivariate Cox regression models, AGR and NLR were stably independent prognostic indicators in all models, with Model 2 showing a lowest AIC (AGR: HR = 0.56, 95%CI: 0.41-0.78; NLR: HR = 1.80, 95%CI: 1.07-3.04). Then, a novel AGR-NLR score was established, which showed a more excellent performance than either AGR or NLR alone (area under curve [AUC]: 0.589, 0.559, and 0.556, respectively). The C-index of the nomogram based on AGR-NLR was superior to that of traditional TNM staging system (C-index: 0.658 versus. 0.596, p < .001). Similar results were also showed by decision curve analysis, indicating the nomogram had more positive net benefit compared to TNM staging system.
The novel AGR-NLR score is strongly associated with outcome in patients with OSCC and could be serve as a useful tool to accurately predict the OS of OSCC patients.
探讨全身炎症生物标志物（白蛋白/球蛋白比值[AGR]、中性粒细胞/淋巴细胞比值[NLR]和血小板/淋巴细胞比值[PLR]）在口腔鳞状细胞癌（OSCC）患者中的预后价值，并进一步建立一种新的预后评分（AGR-NLR）。
本研究开展了一项大型前瞻性研究，共纳入 2002 年 12 月至 2018 年 6 月期间在福建医科大学附属第一医院就诊的 792 例符合条件的患者。通过赤池信息量准则（AIC）评估全身炎症生物标志物与总生存（OS）的相关性，建立了三个多变量 Cox 回归模型。然后，建立了一个新的 AGR-NLR 评分，并将其纳入一个预后列线图。
在单因素分析中，AGR 的增加与死亡风险降低相关。相反，NLR 和 PLR 越高，OS 越差。在多变量 Cox 回归模型中，AGR 和 NLR 在所有模型中均为稳定的独立预后指标，其中模型 2 的 AIC 最低（AGR：HR=0.56，95%CI：0.41-0.78；NLR：HR=1.80，95%CI：1.07-3.04）。然后，建立了一个新的 AGR-NLR 评分，其性能优于单独的 AGR 或 NLR（曲线下面积[AUC]：0.589、0.559 和 0.556）。基于 AGR-NLR 的列线图的 C 指数优于传统的 TNM 分期系统（C 指数：0.658 与 0.596，p<0.001）。决策曲线分析也表明，与 TNM 分期系统相比，该列线图具有更高的净获益。
新的 AGR-NLR 评分与 OSCC 患者的预后密切相关，可作为准确预测 OSCC 患者 OS 的有用工具。
