摘要
目的探讨治疗前中性粒细胞与淋巴细胞比值(NLR)对接受全雄激素阻断(MAB)治疗的前列腺癌患者预后的影响。方法回顾性分析2007年10月至2017年3月我院接受MAB治疗的249例前列腺癌患者的临床资料。年龄48~89岁,中位年龄72岁。体重指数14.5~31.8kg/m^2,中位值23.0kg/m^2。治疗前PSA 1.00~758.21ng/ml,中位值60.04ng/ml。216例肿瘤侵犯前列腺周围组织,157例有淋巴结转移,174例有其他器官转移。Gleason评分3~10分,中位值7分。美国东部肿瘤协作组(ECOG)评分0~2分,中位值0分。所有患者均行MAB治疗。观察终点为无进展生存期(PFS)及肿瘤特异性生存期(css)。利用受试者工作特征(ROC)曲线确定NLR的临界值。采用Cox风险比例回归模型及Kaplan—Meier生存曲线分析治疗前NLR对接受MAB治疗的前列腺癌患者预后的影响。结果249例随访5—124个月,中位时间29个月。根据患者随访结束时生存或肿瘤特异性死亡结局绘制ROC曲线,得出NLR的临界值为2.29(95%C10.603~0.737,P<0.001),并据此将患者分为高NLR组(NLR≥2.29)和低NLR组(NLR<2.29)。高NLR组119例(47.8%),低NLR组130例(52.2%)。高NLR与高Gleason评分(P=0.019)、高中性粒细胞计数(P<0.001)以及高临床T分期(P=0.001)、N分期(P<0.001)、M分期(P<0.001)显著相关。115例死于前列腺癌,病死率为46.2%,其中低NLR组死亡40例(30.8%),高NLR组死亡75例(63.0%)。Kaplan-Meier生存分析结果表明高NLR组与低NLR组比较,PFS(15.0个月与28.5个月,P<0.001)和CSS(21.0个月与38.0个月,P<0.001)均较短。Cox多因素分析结果显示,NLR、Gleason评分、临床TNM分期、ECOG评分是接受MAB治疗的前列腺癌患者PFS和CSS的独立预后因素(均P<0.05)。结论对于接受NAB治疗的前列腺癌患者,治疗前NLR是患者PFS和CSS的独立预测因素。
Objective To evaluate the prognostic value of pretreatment neutrophil to lymphocyte ratio (NLR)on prostate cancer patients treated with maximal androgen blockade (MAB).Methods The clinical data of 249 prostate cancer patients treated with MAB in our hospital from October 2007 to March 2017 were retrospectively analyzed.Among all the patients,the median age was 72 years old (ranged 48 to 89 years).The BMI was 14.5-31.8kg/m2(median 23.0kg/m2).The PSA was 1.00-758.21ng/ml (median 60.04ng/ml).216 patients'tumor invaded surrounding tissues;lymph node metastasis occurred in 157patients;and distant organ metastasis occurred in the remaining 174patients.The Gleason score was 3-10(median 7).Coprimary end points were progression-free survival (PFS)and cancer-specific survival (CSS).The best cutoff value of NLR was calculated by receiver operating characteristic (ROC)curve.The prognostic analysis of NLR on prostate cancer patients treated with MAB was estimated using Cox proportional hazards models and Kaplan-Meier analysis.Results The ideal cutoff value of the pretreatment NLR was 2.29(95%CI 0.603-0.737,P <0.001)determined by the ROC curve according to the survived and deceased cases at the end point of CSS,by which the 249 patients was divided into the high NLR group of 119patients (47.8%) and the low NLR group of 130 patients (52.2%).High NLR was significantly associated with high Gleason score (P =0.019),higher clinical T stage (P =0.001),N stage (P < 0.001),M stage (P <0.001)and more neutrophil count (P <0.001).The median follow-up time was 29 months (ranged 5to 124).During this period,115patients died,and the whole fatality rate was 46.2%. 40 patients died in low NLR group (30.8%),while the figures for the high NLR group were 75(63.0%). Kaplan-Meier analysis demonstrated that patients with NLR ≥2.29 had a poor outcome both in PFS (P < 0.001)and CSS (P <0.001).The multivariate Cox analysis showed that NLR,Gleason score,clinical TNM stage and ECOG score were independent predictors for PFS and CSS.Conclusion Pretreatment NLR could be an independent prognostic biomarker for PFS and CSS in prostate cancer patients undergoing MAB.
作者
王宁
刘建业
邓敏华
赵雄剑
高军
张一川
汤进
龙智
何乐业
Wang Ning;Liu Jianye;Deng Minhua;Zhao Xiongjian;Gao Jun;Zhang Yichuan;Tang Jin;Long Zhi;He Leye(Department of Urology,The Third Xiangya Hospital of Central South University,Institute of Prostate Disease of Central South University,Changsha 410013,China)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2018年第12期911-915,共5页
Chinese Journal of Urology
