摘要
目的分析放疗前中性粒细胞淋巴细胞比值（NLR）对局部晚期非小细胞肺癌（NSCLC）患者的预后评估价值。方法回顾性分析2007年1月至2010年12月中国医学科学院肿瘤医院收治的420例接受单纯放疗、序贯放化疗或同步放化疗局部晚期NSCLC患者的临床和随访资料。分析患者放疗前外周血NLR与临床的相关性，通过建立受试者工作特征曲线（ROC），获得最佳界值，将患者分为高NLR组和低NLR组，通过Kaplan-Meier法绘制患者的生存曲线，log rank法比较高NLR组和低NLR组患者的生存，通过Cox比例风险回归模型进行多因素分析。结果420例患者中，接受单纯放疗、序贯放化疗和同步放化疗者分别为99例（23.6%）、139例（33.1%）和182例（43.3%）。全组有75例患者生存，中位随访时间为5.2年，中位生存时间为22个月。放疗前NLR的最佳界值为2.1。放疗前高NLR组和低NLR组患者的5年无进展生存率分别为10.6%和15.7%（P＝0.033），5年总生存率分别为15.5%和22.7%（P＝0.012）。Cox多因素分析显示，NLR为影响局部晚期NSCLC患者预后的独立因素（HR＝1.06，95%CI为1.003～1.135，P＝0.041）。结论放疗前NLR升高对于接受放疗的局部晚期NSCLC患者，是独立的不良预后因素，但NLR受患者状态和治疗影响较大，仍需进一步深入研究。
ObjectiveThe aim of this retrospective study was to evaluate the prognostic significance of pretreatment Neutrophil-to-Lymphocyte Ratio（NLR） in locally advanced non-small cell lung cancer（NSCLC） patients treated with thoracic radiotherapy.MethodsWe retrospectively analyze 420 patients who received thoracic radiotherapy alone, sequential chemoraiotherapy or concurrent chemoradiotherapy for locally advanced stage NSCLC from January 2007 to December 2010 of our hospital. The patients were divided into two groups （high NLR group and low NLR group） with appropriate cutoff point using the receiver operating characteristic （ROC） curve method. The survival curve was established by Kaplan-Meier method. The Log-rank test was used to compare the survival of the two NLR groups and the multivariate analysis was carried out by Cox regression model.ResultsAmong the 420 patients, 99 received radiotherapy alone, 139 received sequential chemoradiotherapy and 182 received concurrent chemoradiotherapy. 345 patients died and 75 were still alive. The median follow-up time was 5.2 years and the median overall survival was 22 months. The cut-off value of pretreatment NLR was 2.1. The 5-year PFS and OS rates in high NLR group and low NLR group were 10.6% vs 15.7% （P=0.033） and 15.5% vs 22.7% （P=0.012）. Multivariate analysis confirmed that pretreatment NLR （hazard ratio 1.06, P=0.041） was independent prognostic factor of OS.ConclusionsOur study revealed that the pretreatment NLR is the independent prognostic factor of OS in patients with locally advanced stage NSCLC treated with thoracic radiotherapy. However, NLR is still greatly influenced by patient′s condition and treatment which needs further research.
作者
董昕
周宗玫
毕楠
王静波
冉俊涛
惠周光
梁军
冯勤付
陈东福
肖泽芬
吕纪马
王小震
王鑫
张涛
邓垒
王文卿
王绿化
Dong Xin;Zhou Zongmei;Bi Nan;Wang Jingbo;Ran Juntao;Hui Zhouguang;Liang Jun;Feng Qinfu;Chen Dongfu;Xiao Zefen;Lyu Jima;Wang Xiaozhen;Wang Xin;Zhang Tao;Deng Lei;Wang Wenqing;Wang Luhua(Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China)
出处
《中华肿瘤杂志》
CAS
CSCD
北大核心
2018年第6期446-451,共6页
Chinese Journal of Oncology
基金
国家自然科学基金青年科学基金项目资助（81402531）
中国医学科学院医学与健康科技创新工程（2016-12M-1-001）
十大疾病科技成果推广（Z161100000516224）
关键词
癌
非小细胞肺
放射治疗
局部晚期
粒细胞淋巴细胞比值
Neoplasms
non-small cell lung
Radiotherapy
Locally advanced
Neutrophil-to-lymphocyte ratio
