2005 - 2018年美国国家健康与营养检查调查（NHANES）中癌症成年患者中性粒细胞与淋巴细胞比值与全因死亡率和心血管死亡率之间的关联：一项回顾性队列研究
Association between neutrophil-to-lymphocyte ratio and all-cause and cardiovascular mortality among adults with cancer from NHANES 2005-2018: a retrospective cohort study.
作者信息
Li Gangping, Fu Yuewen, Zhang Di
机构信息
Department of Hematology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China.
Department of Medical Records Management, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China.
出版信息
Front Oncol. 2025 Mar 18;15:1521099. doi: 10.3389/fonc.2025.1521099. eCollection 2025.
BACKGROUND
Evidence on the association between the neutrophil-to-lymphocyte ratio (NLR) and all-cause and cardiovascular disease (CVD) mortality in adults with cancer is limited.
AIMS
This study aimed to examine the relationship between NLR and all-cause and CVD mortality in adults with cancer.
METHODS
A retrospective cohort study included 2,639 cancer patients in the U.S. from the NHANES dataset (2005-2018), collecting demographic, laboratory, and mortality data. Multivariable Cox regression analysis, subgroup analysis and restricted cubic spline analyses assessed the associations between NLR and mortality outcomes.
RESULTS
During a median follow-up of 77 months, 713 (27.0%) deaths occurred, including 149 (5.6%) from CVD. Multivariable Cox regression analysis revealed that a high NLR, treated as a continuous variable, was significantly correlated with increased all-cause mortality (HR, 1.09; 95% CI, 1.05-1.12; p < 0.001) and CVD mortality (HR, 1.12; 95% CI, 1.05-1.19; p < 0.001). Meanwhile, when evaluating NLR as a categorical variable, the adjusted hazard ratios (HR) for NLR and all-cause mortality in quartiles Q2 (1.6-2.2), Q3 (2.2-3), and Q4 (>3) were 1.06 (95% CI: 0.83-1.34, p = 0.062), 1.12 (95% CI: 0.89-1.42, p = 0.334), and 1.30 (95% CI: 1.04-1.63, p = 0.021), respectively, when compared with individuals in the lower quartile Q1 (≤1.6). In terms of CVD mortality, the adjusted HR values for NLR in Q2, Q3, and Q4 were 0.92 (95% CI: 0.50-1.69, p = 0.062), 1.24 (95% CI: 0.71-12.19, p = 0.334), and 1.76 (95% CI: 1.04-2.97, p = 0.034), respectively, compared to those in the lower NLR quartile Q1 (≤1.6). Subgroup analysis showed similar patterns (all p-values for interaction > 0.05). Kaplan-Meier analysis indicated lower survival rates for individuals with higher NLR, and RCS analysis suggested a positive linear relationship between NLR and all-cause and CVD mortality.
CONCLUSION
Elevated NLR is linked to higher all-cause and CVD mortality risks among adults with cancer.
背景
关于中性粒细胞与淋巴细胞比值（NLR）与癌症成年患者全因死亡率和心血管疾病（CVD）死亡率之间关联的证据有限。
目的
本研究旨在探讨NLR与癌症成年患者全因死亡率和CVD死亡率之间的关系。
方法
一项回顾性队列研究纳入了来自美国国家健康与营养检查调查（NHANES）数据集（2005 - 2018年）的2639例癌症患者，收集了人口统计学、实验室检查和死亡率数据。多变量Cox回归分析、亚组分析和限制性立方样条分析评估了NLR与死亡率结局之间的关联。
结果
在中位随访77个月期间，发生了713例（27.0%）死亡，其中149例（5.6%）死于CVD。多变量Cox回归分析显示，将高NLR作为连续变量时，其与全因死亡率增加显著相关（HR = 1.09；95%CI：1.05 - 1.12；p < 0.001）和CVD死亡率增加显著相关（HR = 1.12；95%CI：1.05 - 1.19；p < 0.001）。同时，当将NLR作为分类变量评估时，与NLR较低的第一四分位数Q1（≤1.6）中的个体相比，第二四分位数Q2（1.6 - 2.2）、第三四分位数Q3（2.2 - 3）和第四四分位数Q4（>3）中NLR与全因死亡率的调整后风险比（HR）分别为1.06（95%CI：0.83 - 1.34，p = 0.062）、1.12（95%CI：0.89 - 1.42，p = 0.334）和1.30（95%CI：1.04 - 1.63，p = 0.021）。就CVD死亡率而言，与NLR较低的第一四分位数Q1（≤1.6）中的个体相比，第二四分位数Q2、第三四分位数Q3和第四四分位数Q4中NLR的调整后HR值分别为0.92（95%CI：0.50 - 1.69，p = 0.062）、1.24（95%CI：0.71 - 12.19，p = 0.334）和1.76（95%CI：1.04 - 2.97，p = 0.034）。亚组分析显示了相似的模式（所有交互作用的p值>0.05）。Kaplan - Meier分析表明NLR较高的个体生存率较低，并且限制性立方样条分析表明NLR与全因死亡率和CVD死亡率之间存在正线性关系。
结论
NLR升高与癌症成年患者较高的全因死亡率和CVD死亡率风险相关。
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