中性粒细胞与淋巴细胞比值及化疗反应评分作为新辅助化疗治疗卵巢癌患者的预后标志物。

Neutrophil-to-lymphocyte ratio and chemotherapy response score as prognostic markers in ovarian cancer patients treated with neoadjuvant chemotherapy.

机构信息

Department of Clinical Therapeutics, Alexandra General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.

Department of Obstetrics and Gynecology, Alexandra General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.

出版信息

J Ovarian Res. 2021 Nov 1;14(1):148. doi: 10.1186/s13048-021-00902-0.

BACKGROUND

Neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) is the recommended approach in patients with advanced epithelial ovarian cancer (EOC). However, most patients eventually relapse despite the initial high response rate to chemotherapy. Neutrophil-to-lymphocyte ratio is a well-known biomarker that reflects severe inflammation, critical illness, and mortality in various diseases. Chemotherapy response score (CRS) and neutrophil-to-lymphocyte ratio (NLR) have been identified as potential biomarkers of platinum resistance and disease prognosis. We retrospectively evaluated 132 patients with stage IIIc or IV ovarian/fallopian tube/primary peritoneal cancer who had received NACT followed by IDS from 01/01/2003 to 31/12/2018. CRS was assessed on omental specimens collected from IDS according to ICCR guidelines.

RESULTS

Median age was 64.57 years (SD: 9.72; range 39.2-87.1). Most ovarian tumors were serous epithelial (90.9%; 120/132). An elevated NLR (defined as > 3) was observed in 72% (95/132) of patients in contrast with 28% (37/132) of patients characterized by low NLR status. Median PFS (mPFS) and median overall survival (mOS) were 13.05 months (95% CI: 11.42-14.67)) and 34.69 months (95% CI: 23.26-46.12) respectively. In univariate analysis, CRS3 score was significantly associated with prolonged mPFS (CRS1/2: 12.79 months vs CRS3: 17.7 months; P = 0.008). CRS score was not associated with mOS (P = 0.876). High NLR was not significantly associated with mPFS (P = 0.128), however it was significantly associated with poor mOS (P = 0.012). In multivariate analysis, only performance of surgery maintained its statistical significance with both PFS (P = 0.001) and OS (P = 0.008).

CONCLUSION

NLR could serve as a useful predictor of OS but not PFS in ovarian cancer patients receiving NACT. In accordance with our previous study, CRS score at omentum was found to be associated with PFS but not OS in ovarian cancer patients treated with NACT and IDS.

背景

新辅助化疗（NACT）后间隔减瘤手术（IDS）是晚期上皮性卵巢癌（EOC）患者的推荐治疗方法。然而，尽管化疗初始反应率很高，大多数患者最终仍会复发。中性粒细胞与淋巴细胞比值是一种众所周知的生物标志物，可反映各种疾病中的严重炎症、危重病和死亡率。化疗反应评分（CRS）和中性粒细胞与淋巴细胞比值（NLR）已被确定为铂类耐药和疾病预后的潜在生物标志物。我们回顾性评估了 2003 年 1 月 1 日至 2018 年 12 月 31 日期间接受 NACT 后 IDS 的 132 名 IIIc 期或 IV 期卵巢/输卵管/原发性腹膜癌患者。根据 ICCR 指南，在 IDS 时从网膜标本中评估 CRS。

结果

中位年龄为 64.57 岁（标准差：9.72；范围 39.2-87.1）。大多数卵巢肿瘤为浆液性上皮（90.9%；120/132）。与低 NLR 状态的 28%（37/132）患者相比，72%（95/132）的患者存在 NLR 升高（定义为>3）。中位无进展生存期（mPFS）和中位总生存期（mOS）分别为 13.05 个月（95%CI：11.42-14.67）和 34.69 个月（95%CI：23.26-46.12）。单因素分析显示，CRS3 评分与延长 mPFS 显著相关（CRS1/2：12.79 个月比 CRS3：17.7 个月；P=0.008）。CRS 评分与 mOS 无关（P=0.876）。高 NLR 与 mPFS 无显著相关性（P=0.128），但与 mOS 不良显著相关（P=0.012）。多因素分析显示，只有手术的执行情况在 PFS（P=0.001）和 OS（P=0.008）方面保持统计学意义。