淋巴细胞-单核细胞比值在老年食管癌根治性放化疗患者预后中的临床意义

郭术楠; 汪庚明; 陈蔓; 潘全; 周咏春; 朱超莽

doi:10.16766/j.cnki.issn.1674-4152.003195

淋巴细胞-单核细胞比值在老年食管癌根治性放化疗患者预后中的临床意义

doi: 10.16766/j.cnki.issn.1674-4152.003195

郭术楠¹,
汪庚明^{1, 2, ,},
陈蔓¹,
潘全¹,
周咏春^{1, 2},
朱超莽^{1, 2}

1.
蚌埠医学院第一附属医院肿瘤放疗科, 安徽蚌埠 233004
2.
癌症转化医学安徽省重点实验室(蚌埠医学院)，安徽蚌埠 233000

基金项目:

安徽省高校自然科学研究重点项目 KJ2018A0241

安徽省临床医学优先发展重点专科基金项目卫科教秘[2018]291号

详细信息

通讯作者:
汪庚明，E-mail：lansefeidian777@163.com

中图分类号: R735.1 R730.7
计量
- 文章访问数: 235
- HTML全文浏览量: 151
- PDF下载量: 26
- 被引次数: 0
出版历程
- 收稿日期: 2022-03-21
- 网络出版日期: 2023-11-23

Clinical significance of lymphocyte-monocyte ratio in the prognosis of elderly patients undergoing curative chemoradiotherapy for esophageal cancer

GUO Shunan¹,
WANG Gengming^{1, 2
, ,},
CHEN Man¹,
PAN Quan¹,
ZHOU Yongchun^{1, 2},
ZHU Chaomang^{1, 2}

1.
Department of Radiation Oncology, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的分析根治性放化疗前淋巴细胞-单核细胞比值(lymphocyte-to-monocyte ratio, LMR)对老年食管癌(esophagus cancer，EC)患者预后的评估价值。方法收集2014年1月—2017年12月在蚌埠医学院第一附属医院放射肿瘤科接受EC根治性放化疗的老年(≥65岁)患者220例，回顾性分析所纳入患者的临床数据及实验室检验指标。通过建立受试者工作特征曲线，约登指数最大值时的LMR为4.9，将LMR=4.9作为临界值，分为高LMR组(＞4.9，69例)和低LMR组(≤4.9，151例)，通过Kaplan-Meier方法绘制2组患者的生存曲线，采用Log Rank法比较2组患者的生存状况，通过Cox回归模型进行多因素分析。结果全组共有82例患者生存，总体中位随访时间为45个月，总体中位生存时间为28个月。高LMR组和低LMR组患者的5年无进展生存率分别为38.6%和29.8%(P=0.005)，5年总生存率分别为47.0%和26.5%(P=0.003)。Cox回归模型多因素分析结果显示，根治性放化疗前LMR值是老年EC患者预后的独立影响因素(HR=0.634，95% CI：0.422~0.954，P=0.029)。结论对于接受根治性放化疗的老年EC患者来说，根治性放化疗前LMR降低是独立不良预后因素。
- 老年患者 /
- 食管癌 /
- 根治性放化疗 /
- 淋巴细胞-单核细胞比值 /
- 预后
Abstract: Objective To analyze the prognostic value of lymphocyte to monocyte ratio (LMR) in elderly patients with esophageal cancer (EC). Methods A total of 220 elderly (≥65 years) patients who underwent radical chemoradiotherapy for EC at the Radiation Oncology Department of the First Affiliated Hospital of Bengbu Medical College from January 2014 to December 2017 were enrolled, and the clinical data and laboratory test indexes of the included patients were retrospectively reviewed. By constructing receiver operating characteristic curve, the LMR at the maximum value of Youden index was 4.9, and LMR=4.9 was used as the cut-off value to divide the patients into high LMR group (>4.9, 69 cases) and low LMR group (≤4.9, 151 cases), the survival curves of the two groups were plotted by Kaplan-Meier method, log-rank method to compare the survival status of the two groups, and multivariate analysis was performed by Cox regression model. Results A total of 82 patients were alive in the whole group with a median overall follow-up of 45 months and a median overall survival time of 28 months. The 5-year progression-free survival rates of patients in the high and low LMR groups before radical chemoradiotherapy were 38.6% and 29.8%, respectively (P=0.005), and the 5-year overall survival rates were 47.0% and 26.5%, respectively (P=0.003). By Cox regression model multivariate analysis, the results showed that LMR value before radical chemoradiotherapy was an independent factor affecting the prognosis of elderly EC patients (HR=0.634, 95% CI: 0.422-0.954, P=0.029). Conclusion In elderly EC patients receiving radical chemoradiotherapy, reduced LMR prior to radical chemoradiotherapy was an independent adverse prognostic factor.
- Elderly patients /
- Esophageal cancer /
- Radiotherapy /
- Lymphocyte-to-monocyte ratio /
- Prognosis

HTML全文

图 1 LMR对老年EC患者预后的ROC曲线

Figure 1. ROC curve analysis assessing the prognosis of LMR in elderly patients with EC

下载: 全尺寸图片幻灯片

图 2 高LMR组和低LMR组老年EC患者OS的K-M生存曲线

Figure 2. K-M survival curves of OS in elderly EC patients in high and low LMR groups

下载: 全尺寸图片幻灯片

图 3 高LMR组和低LMR组老年EC患者PFS的K-M生存曲线

Figure 3. K-M survival curves of PFS in elderly EC patients in high and low LMR groups

下载: 全尺寸图片幻灯片

表 1 高LMR组和低LMR组患者的一般临床资料比较(例)

Table 1. Comparison of general clinical characteristics between patients in the high LMR group and low LMR group (cases)

因素	高LMR组(n=69)	低LMR组(n=151)	统计量	P值
性别			2.485^a	0.149
男性	44	112
女性	25	39
肿瘤位置			1.375^b	0.711
颈段	5	6
胸上段	20	49
胸中段	26	53
胸下段	18	43
肿瘤分期			-1.181^b	0.238
Ⅰ期	24	37
Ⅱ期	29	76
Ⅲ期	16	38
病理类型			0.247^a	0.619
鳞癌	65	146
腺癌	4	5
饮酒			0.091^a	0.837
是	9	22
否	60	129
放疗剂量			0.119^a	0.772
高剂量	33	76
低剂量	36	75
注：^a为χ²值，^b为Z值。

下载: 导出CSV

表 2 影响老年食管癌放疗患者预后的单因素分析

Table 2. Univariate analysis of prognostic factors in elderly patients with esophageal cancer undergoing radiotherapy

项目	例数	中位生存时间(月)	χ²值	P值	中位无进展时间(月)	χ²值	P值
性别
男性	156	29.0(23.5~34.5)	1.366	0.243	21.0(16.7~25.3)	2.023	0.037
女性	64	28.0(8.3~47.7)			25.0(7.7~42.3)
肿瘤分期
Ⅰ期	61	43.0(31.5~54.5)	8.688	0.013	29.0(23.3~34.7)	9.749	0.070
Ⅱ期	105	30.0(21.8~38.2)			22.0(14.5~29.5)
Ⅲ期	54	17.0(12.0~22.0)			11.0(7.0~15.0)
病理类型
鳞癌	211	29.0(23.9~34.1)	0.036	0.850	22.0(18.4~25.6)	0.002	0.824
腺癌	9	21.0(3.7~38.5)			19.0(4.4~33.6)
放疗前LMR
≤4.9	151	24.0(18.6~29.4)	8.640	0.003	20.0(16.9~23.1)	7.925	0.005
＞4.9	69	56.0(25.2~70.0)			45.0(20.1~70.0)
肿瘤部位
颈段	11	43.0(19.2~66.8)	4.818	0.186	30.0(9.5~50.5)	4.189	0.348
胸上段	69	33.0(11.0~55.0)			25.0(16.9~33.1)
胸中段	79	32.0(24.2~39.8)			23.0(13.3~32.7)
胸下段	61	22.0(17.7~26.3)			19.0(14.6~23.4)
放疗剂量
高剂量	109	30.0(22.3~37.7)	0.017	0.896	22.0(18.6~25.4)	0.004	0.799
低剂量	111	28.0(19.3~36.7)			23.0(17.8~28.2)

下载: 导出CSV

表 3 影响老年食管癌放疗患者预后的多因素分析

Table 3. Multivariable analysis of prognostic factors in elderly patients with esophageal cancer undergoing radiotherapy

项目	B	SE	Wald χ²	P值	HR值	95% CI
性别	-0.084	0.201	0.165	0.684	0.919	0.612~1.381
肿瘤分期	0.682	0.120	7.963	0.005	1.978	1.232~3.177
放疗前LMR	-0.455	0.203	4.782	0.029	0.634	0.422~0.954

下载: 导出CSV

参考文献(15)

[1]	SUNG H, FERLAY J, SIEGEL R L, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71(3): 209-249. doi: 10.3322/caac.21660
[2]	ALLEMANI C, MATSUDA T, DI CARLO V, et al. Global surveillance of trends in cancer survival 2000-14 (CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries[J]. Lancet, 2018, 391(10125): 1023-1075. doi: 10.1016/S0140-6736(17)33326-3
[3]	MALHOTRA G K, YANALA U, RAVIPATI A, et al. Global trends in esophageal cancer[J]. J Surg Oncol, 2017, 115(5): 564-579. doi: 10.1002/jso.24592
[4]	CHEN M F, CHEN P T, LU M S, et al. Survival benefit of surgery to patients with esophageal squamous cell carcinoma[J]. Sci Rep, 2017, 7(4): 61-69.
[5]	ISHIBASHI Y, TSUJIMOTO H, HIRAKI S, et al. Prognostic value of preoperative systemic immunoinflammatory measures in patients with esophageal cancer[J]. Ann Surg Oncol, 2018, 25(11): 3288-3299. doi: 10.1245/s10434-018-6651-y
[6]	YODYING H, MATSUDA A, MIYASHITA M, et al. Prognostic significance of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in oncologic outcomes of esophageal cancer: a systematic review and meta-analysis[J]. Ann Surg Oncol, 2016, 23(2): 646-654. doi: 10.1245/s10434-015-4869-5
[7]	TAKENAKA Y, OYA R, KITAMIURA T, et al. Prognostic role of neutrophil-to-lymphocyte ratio in head and neck cancer: a meta-analysis[J]. Head Neck, 2018, 40(3): 647-655. doi: 10.1002/hed.24986
[8]	XIE X, LUO K J, HU Y, et al. Prognostic value of preoperative platelet-lymphocyte and neutrophil-lymphocyte ratio in patients undergoing surgery for esophageal squamous cell cancer[J]. Dis Esophagus, 2016, 29(1): 79-85. doi: 10.1111/dote.12296
[9]	王桂峰, 崔珍, 万强琨, 等. 老年食管鳞癌根治性同步放化疗后替吉奥辅助化疗的疗效观察与预后因素分析[J]. 中华全科医学, 2021, 19(3): 379-382, 453. doi: 10.16766/j.cnki.issn.1674-4152.001815 WANG G F, CUI Z, WAN Q K, et al. Observation of curative effect and analysis of prognostic factors of S-1 adjuvant chemotherapy after radical concurrent chemoradiotherapy for esophageal squamous cell carcinoma in the elderly[J]. Chinese Journal of General Practice, 2021, 19(3): 379-382, 453. doi: 10.16766/j.cnki.issn.1674-4152.001815
[10]	SINGH R, MISHRA M K, AGGRRWAL H. Inflammation, immunity, and cancer[J]. Mediators Inflamm, 2017, 2017(602): 7305.
[11]	ZHOU X L, ZHU W G, ZHU Z J, et al. Lymphopenia in esophageal squamous cell carcinoma: relationship to malnutrition, various disease parameters, and response to concurrent chemoradiotherapy[J]. Oncologist, 2019, 24(8): 677-686. doi: 10.1634/theoncologist.2018-0723
[12]	HIRAHARA N, MATSUBARA T, MIZOTA Y, et al. Prognostic value of preoperative inflammatory response biomarkers in patients with esophageal cancer who undergo a curative thoracoscopic esophagectomy[J]. BMC Surg, 2016, 16(1): 66. doi: 10.1186/s12893-016-0179-5
[13]	HAN L H, JIA Y B, SONG Q X, et al. Prognostic significance of preoperative lymphocyte-monocyte ratio in patients with resectable esophageal squamous cell carcinoma[J]. Asian Pac J cancer Prev, 2015, 16(6): 2245-2250. doi: 10.7314/APJCP.2015.16.6.2245
[14]	LI K J, XIA X F, SU M, et al. Predictive value of lymphocyte-to-monocyte ratio (LMR) and neutrophil-to-lymphocyte ratio (NLR) in patients with oesophageal cancer undergoing concurrent chemoradiotherapy[J]. BMC Cancer, 2019, 19(1): 1004. doi: 10.1186/s12885-019-6157-4
[15]	HU G, LIU G, MA J Y, et al. Lymphocyte-to-monocyte ratio in esophageal squamous cell carcinoma prognosis[J]. Clin Chim Acta, 2018, 486: 44-48. doi: 10.1016/j.cca.2018.07.029