Department of Radiation Oncology, Baskent University Medical Faculty, Adana, Turkey.
Department of Radiation Oncology, Koc University Schoolof Medicine, Istanbul, Turkey.
Int J Clin Pract. 2022 Jan 31;2022:7473649. doi: 10.1155/2022/7473649. eCollection 2022.
Our retrospective research included a sum of 126 LAPAC patients who received CCRT. The NLR was calculated for each patient based on the complete blood count test results obtained on the last day of the CCRT. The availability of optimal cutoff(s) that might dichotomize the whole cohort into two groups with significantly different clinical outcomes was searched using receiver operating characteristic (ROC) curve analysis. Primary and secondary endpoints were the potential association between the post-CCRT NLR measures and distant metastasis-free survival (DMFS) and overall survival (OS) outcomes.
The median follow-up duration was 14.7 months (range: 2.4-94.5). The median and 3-year OS and DMFS rates for the whole group were 15.3 months (95% confidence interval: 12.4-18.2) and 14.5%, and 8.7 months (95% CI: 6.7-10.7) and 6.3% separately. The ROC curve analysis findings separated the patients into two groups on a rounded NLR cutoff of 3.1 (area under the curve (AUC): 75.4%; sensitivity: 74.2%; specificity: 73.9%) for OS and DMFS: NLR <3.1 ( = 62) and NLR ≥3.1 ( = 64), respectively. Comparisons between the NLR groups displayed that the median OS (11.4 vs. 21.4 months; < 0.001) and DMFS (6.0 vs. 16.0 months; < 0.001) lengths were significantly shorter in the NLR ≥3.1 group than its NLR <3.1 counterparts, as well as the 3-year actuarial DM rate (79.7% vs. 50.0%; =0.003). The N1-2 nodal stage, CA 19-9>90 U/mL, and NLR >3.1 were found to be independent predictors of poor prognosis in the multivariate analysis.
The present study found that the posttreatment NLR ≥3.1 was independently linked with a higher risk of DM and subsequent degraded survival outcomes in unresectable LAPAC patients managed with exclusive CCRT.
我们的回顾性研究纳入了 126 例接受 CCRT 的 LAPAC 患者。根据 CCRT 最后一天的全血细胞计数检测结果，为每位患者计算 NLR。使用接受者操作特征（ROC）曲线分析搜索可能将整个队列分为两组的最佳截断值（s），这两组具有显著不同的临床结局。主要和次要终点是治疗后 NLR 与无远处转移生存（DMFS）和总生存（OS）结局之间的潜在相关性。
中位随访时间为 14.7 个月（范围：2.4-94.5）。全组患者的中位 OS 和 DMFS 分别为 15.3 个月（95%置信区间：12.4-18.2）和 14.5%，8.7 个月（95%CI：6.7-10.7）和 6.3%。ROC 曲线分析结果将患者分为两组，取 NLR 截断值为 3.1（曲线下面积（AUC）：75.4%；敏感性：74.2%；特异性：73.9%），分别为 OS 和 DMFS：NLR <3.1（ = 62）和 NLR ≥3.1（ = 64）。NLR 组之间的比较显示，NLR ≥3.1 组的中位 OS（11.4 与 21.4 个月；<0.001）和 DMFS（6.0 与 16.0 个月；<0.001）明显短于 NLR <3.1 组，以及 3 年估计 DM 率（79.7%比 50.0%；=0.003）。多变量分析发现，N1-2 淋巴结分期、CA 19-9>90 U/mL 和 NLR>3.1 是不可切除 LAPAC 患者接受单纯 CCRT 治疗后预后不良的独立预测因素。
本研究发现，治疗后 NLR≥3.1 与不可切除 LAPAC 患者接受单纯 CCRT 治疗后 DM 风险增加和生存结局恶化独立相关。
