酪氨酸激酶抑制剂治疗甲状腺癌患者中性粒细胞与淋巴细胞比值的时间序列行为。

The Time Series Behavior of Neutrophil-to-Lymphocyte Ratio in Thyroid Cancer Patients on Tyrosine Kinase Inhibitor Therapy.

机构信息

Department of Surgery, Ito Hospital, Tokyo, Japan,

Department of Surgery, Ito Hospital, Tokyo, Japan.

出版信息

ORL J Otorhinolaryngol Relat Spec. 2021;83(5):347-353. doi: 10.1159/000514228. Epub 2021 Mar 18.

DOI:10.1159/000514228

PMID:33735904

Abstract

INTRODUCTION

The neutrophil-to-lymphocyte ratio (NLR) reveals the balance of immune system is and associated with survival in various type of cancers. Tyrosine kinase inhibitors (TKI) improve patient survival with progressing thyroid cancer and are said to have less side effects, and are considered good palliation.

OBJECTIVE

This study evaluated the time series behavior of NLR in advanced thyroid carcinoma patients on TKI therapy and examined what percentage of patients received TKIs in the last month of life.

METHODS

We retrospectively reviewed medical records on 72 patients with advanced thyroid carcinoma treated with TKIs between May 2015 and October 2018. All patients had progressive disease and/or uncontrolled distant metastasis. Fifty-two patients had differentiated thyroid carcinoma (DTC), 19 patients had anaplastic carcinoma (ATC), and 1 had squamous cell carcinoma. NLR was calculated as the absolute neutrophil count divided by the absolute lymphocyte count. Median follow-up time in DTC and ATC patients was 12.3 months (range 0.9-40.4) and 2.7 months (range 0.6-14.3), respectively.

RESULTS

In DTC patients, median NLR at initial treatment, at initiation of TKI, and for 20 patients who died at the time of death was 2.25 (range, 0.89-9.78), 3.55 (range, 0.86-28.3), and 11.78 (range, 0.98-98.0), respectively. In ATC patients, median NLR at initial treatment, at initiation of TKI, and for 16 patients who died at the time of death was 2.96 (range, 1.12-9.0), 11.43 (range, 2.32-95.0), and 16.9 (range, 3.45-95.0), respectively. NLR >10 at TKI initiation was significantly associated with shorter overall survival compared with NLR <4 and NLR 4-10 (p < 0.0001) in DTC patients. Among 46 dead patients, 32 patients (68.1%) received TKIs treatment in the last month of life (85% DTC patients and 61.5% ATC patients). In receiver operating characteristic curve analysis, cutoffs for DTC and ATC were 11.43 (p = 0.0488, area under the ROC curve 0.941) and 31.67 (p = 0.0034, area under the ROC curve 0.831) in patients who survived ≤6 weeks and >6 weeks, respectively.

CONCLUSION

A substantial percentage of patients received TKIs in the last month of life. The NLR increased according to tumor progression and predicted survival after TKI initiation. We might refer the patients with NLR >11.43 in DTC and those with NLR >31.67 in ATC to a hospice/palliative care program.

摘要

简介

中性粒细胞与淋巴细胞比值（NLR）反映了免疫系统的平衡状态，与各种类型癌症的生存相关。酪氨酸激酶抑制剂（TKI）可改善进展期甲状腺癌患者的生存，并被认为副作用较小，是一种较好的姑息治疗方法。

目的

本研究评估了接受 TKI 治疗的晚期甲状腺癌患者 NLR 的时间序列行为，并研究了在最后一个月的生命中，有多少患者接受了 TKI 治疗。

方法

我们回顾性分析了 2015 年 5 月至 2018 年 10 月期间接受 TKI 治疗的 72 例晚期甲状腺癌患者的病历。所有患者均患有进展性疾病和/或无法控制的远处转移。52 例为分化型甲状腺癌（DTC）患者，19 例为间变性甲状腺癌（ATC）患者，1 例为鳞状细胞癌患者。NLR 通过计算绝对中性粒细胞计数除以绝对淋巴细胞计数得出。DTC 和 ATC 患者的中位随访时间分别为 12.3 个月（范围 0.9-40.4）和 2.7 个月（范围 0.6-14.3）。

结果

在 DTC 患者中，初始治疗时、开始 TKI 治疗时和 20 例死亡时的 NLR 中位数分别为 2.25（范围 0.89-9.78）、3.55（范围 0.86-28.3）和 11.78（范围 0.98-98.0）。在 ATC 患者中，初始治疗时、开始 TKI 治疗时和 16 例死亡时的 NLR 中位数分别为 2.96（范围 1.12-9.0）、11.43（范围 2.32-95.0）和 16.9（范围 3.45-95.0）。DTC 患者中，TKI 起始时 NLR >10 与 NLR <4 和 NLR 4-10 相比，总生存期明显缩短（p<0.0001）。在 46 例死亡患者中，32 例（68.1%）在生命的最后一个月接受了 TKI 治疗（85%的 DTC 患者和 61.5%的 ATC 患者）。在受试者工作特征曲线分析中，DTC 和 ATC 的截断值分别为 11.43（p=0.0488，ROC 曲线下面积 0.941）和 31.67（p=0.0034，ROC 曲线下面积 0.831），分别用于预测≤6 周和>6 周生存的患者。