治疗前外周血血红蛋白×淋巴细胞/单核细胞比值对鼻咽癌患者的预后价值
Prognostic value of pretreatment peripheral blood hemoglobin×lymphocyte/monocyte ratio in patients with nasopharyngeal carcinoma.
作者信息
Deng Chao, Chen Zui, Ling Jie, Xie Yangchun, Zhao Xiayan, Hu Chunhong, Liu Xianling, Feng Yuhua, Hou Tao
机构信息
Deparment of Oncology, Second Xiangya Hospital, Changsha 410011, China.
出版信息
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2024 Dec 28;49(12):1909-1918. doi: 10.11817/j.issn.1672-7347.2024.240194.
OBJECTIVES
Peripheral whole blood cell counts have been used as prognostic indicators for various cancers, but their predictive value in nasopharyngeal carcinoma remain unclear. This study aims to evaluate the prognostic significance of the pretreatment hemoglobin×lymphocyte/monocyte ratio (HLMR) in non-recurrent, non-metastatic NPC patients undergoing definitive radiotherapy.
METHODS
Clinical and follow-up data from 805 NPC patients who completed definitive radiotherapy or chemoradiotherapy were retrospectively analyzed. Pretreatment hemoglobin, lymphocyte count, and monocyte count were collected to calculate HLMR. Receiver operating characteristic (ROC) curves were used to determine the optimal cut-off value of HLMR. Patients were then classified into high and low HLMR groups. The association between HLMR and clinicopathological characteristic was assessed using chi-square tests. Independent prognostic factors for overall survival (OS) and progression-free survival (PFS) were identified using Cox proportional hazards models. A nomogram was constructed based on the independent predictors to estimate patient survival rates, and internal validation was performed using a validation cohort.
RESULTS
The ROC curve identified 605.5 as the optimal HLMR cut-off value for predicting 5-year survival. Multivariate Cox regression analysis revealed that T stage (=1.886, 95% 1.331 to 2.673, <0.001), N stage (=2.021, 95% 1.267 to 3.225, =0.003), Eastern Cooperative Oncology Group (ECOG) score (=3.991, 95% 1.257 to 12.677, =0.019), concurrent chemoradiotherapy regimen (=0.338, 95% 0.156 to 0.731, =0.006), and HLMR (=0.648, 95% 0.460 to 0.912, =0.013) were independent prognostic factors for OS. A nomogram including T stage, N stage, and HLMR in the training cohort was constructed to predict 3-, 5-, and 7-year OS, with a C-index of 0.713. The area under the curves for predicting 3-, 5-, and 7-year OS were 0.744, 0.665, and 0.682, respectively. Calibration curves showed good agreement between predicted and observed survival rates. The above results were further confirmed in the validation cohort.
CONCLUSIONS
Pretreatment HLMR may serve as a promising prognostic biomarker for patients with nasopharyngeal carcinoma.
目的
外周全血细胞计数已被用作多种癌症的预后指标，但其在鼻咽癌中的预测价值仍不明确。本研究旨在评估接受根治性放疗的非复发、非转移性鼻咽癌患者治疗前血红蛋白×淋巴细胞/单核细胞比值（HLMR）的预后意义。
方法
回顾性分析805例完成根治性放疗或放化疗的鼻咽癌患者的临床和随访数据。收集治疗前血红蛋白、淋巴细胞计数和单核细胞计数以计算HLMR。采用受试者工作特征（ROC）曲线确定HLMR的最佳截断值。然后将患者分为HLMR高分组和低分组。采用卡方检验评估HLMR与临床病理特征之间的关联。使用Cox比例风险模型确定总生存（OS）和无进展生存（PFS）的独立预后因素。基于独立预测因素构建列线图以估计患者生存率，并使用验证队列进行内部验证。
结果
ROC曲线确定605.5为预测5年生存率的最佳HLMR截断值。多因素Cox回归分析显示，T分期（=1.886，95% 1.331至2.673，<0.001）、N分期（=2.021，95% 1.267至3.225，=0.003）、东部肿瘤协作组（ECOG）评分（=3.991，95% 1.257至12.677，=0.019）、同步放化疗方案（=0.338，95% 0.156至0.731，=0.006）和HLMR（=0.648，95% 0.460至0.912，=0.013）是OS的独立预后因素。在训练队列中构建了包括T分期、N分期和HLMR的列线图以预测3年、5年和7年OS，C指数为0.713。预测3年、5年和7年OS的曲线下面积分别为0.744、0.665和0.682。校准曲线显示预测生存率与观察生存率之间具有良好的一致性。上述结果在验证队列中得到进一步证实。
结论
治疗前HLMR可能是鼻咽癌患者有前景的预后生物标志物。
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