外周血中性粒细胞及血小板与淋巴细胞的比值与局部晚期鼻咽癌预后及疗效的相关性
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摘要
目的探讨中性粒细胞与淋巴细胞比值(neutrophil-to-lymphocyte ratio, NLR)以及血小板与淋巴细胞比值(platelet-lymphocyte ratio, PLR)对局部晚期鼻咽癌患者临床预后及疗效的预测价值。方法收集2015年7月—2016年12月贵州省肿瘤医院一项随机前瞻性临床试验的局部晚期鼻咽癌患者的临床资料。患者均行2周期TPF诱导化疗及顺铂同步放化疗。研究治疗前NLR、PLR与患者治疗疗效的关系。并探讨时辰组及常规组间疗效的差异。结果Ⅳa/b期患者NLR、PLR均值较Ⅲ期患者高(P=0.010);低PLR组治疗后转移淋巴结即刻疗效较高PLR组好(P=0.029),放疗结束3月后原发灶疗效及总体疗效较高PLR组好(P=0.012, P=0.027);高、低NLR及PLR组中常规组及时辰组的治疗后即刻疗效及放疗结束后3月疗效差异无统计学意义(P>0.05)。结论 NLR和PLR均与鼻咽癌临床分期有关,肿瘤分期越晚,NLR和PLR值越高。NLR对患者的近期疗效预测价值欠佳,PLR可能是局部晚期鼻咽癌患者近期疗效的预测指标,高PLR可能预示较差的近期疗效。
Objective To explore the predictive value of neutrophil-to-lymphocyte ratio(NLR) and platelet-to-lymphocyte ratio(PLR) in the prognosis and curative effect of locally advanced nasopharyngeal carcinoma(NPC) patients. Methods We collected the clinical information of locally advanced NPC patients from a randomized prospective clinical trial in Guizhou cancer hospital from July 2015 to December 2016. The patients were treated with two cycles of TPF induction chemotherapy and cisplatin-based concurrent chemoradiotherapy. The relationship between NLR, PLR before treatment and the therapeutic effect of patients was analyzed. We compared the curative effect between chrono-chemotherapy group and routine group. Results The mean values of NLR and PLR in stage Ⅳa/b patients were higher than those in stage Ⅲpatients(P=0.010); the immediate effect of metastatic lymph nodes in low PLR group was better than that in high PLR group(P=0.029), and the curative effect of primary lesion and overall curative effect three months after radiotherapy were better in low PLR group(P=0.012, P=0.027); there was no significant difference in immediate effect or overall curative effect three months after radiotherapy between conventional group and chronological group(P>0.05). Conclusion NLR and PLR are related to the clinical staging of nasopharyngeal carcinoma. The later tumor stage is, the higher NLR and PLR values are. The predictive value of NLR for the patients' short-term efficacy is not well. PLR may be a predictor for recent outcomes of patients with locally advanced nasopharyngeal carcinoma, and high PLR may predict poor short-term efficacy.
Objective To explore the predictive value of neutrophil-to-lymphocyte ratio(NLR) and platelet-to-lymphocyte ratio(PLR) in the prognosis and curative effect of locally advanced nasopharyngeal carcinoma(NPC) patients. Methods We collected the clinical information of locally advanced NPC patients from a randomized prospective clinical trial in Guizhou cancer hospital from July 2015 to December 2016. The patients were treated with two cycles of TPF induction chemotherapy and cisplatin-based concurrent chemoradiotherapy. The relationship between NLR, PLR before treatment and the therapeutic effect of patients was analyzed. We compared the curative effect between chrono-chemotherapy group and routine group. Results The mean values of NLR and PLR in stage Ⅳa/b patients were higher than those in stage Ⅲpatients(P=0.010); the immediate effect of metastatic lymph nodes in low PLR group was better than that in high PLR group(P=0.029), and the curative effect of primary lesion and overall curative effect three months after radiotherapy were better in low PLR group(P=0.012, P=0.027); there was no significant difference in immediate effect or overall curative effect three months after radiotherapy between conventional group and chronological group(P>0.05). Conclusion NLR and PLR are related to the clinical staging of nasopharyngeal carcinoma. The later tumor stage is, the higher NLR and PLR values are. The predictive value of NLR for the patients' short-term efficacy is not well. PLR may be a predictor for recent outcomes of patients with locally advanced nasopharyngeal carcinoma, and high PLR may predict poor short-term efficacy.
引文
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[24]Feng J.Induction Chronochemotherapy Plus Radiation Therapy for Nasopharyngeal Carcinoma:A Phase 2 Prospective Randomized Study[J].Inter J Radiation Oncol Biol Phys,2013,87(2Suppl):S448.
[2]Yang JJ,Hu ZG,Shi WX,et al.Prognostic significance of neutrophil to lymphocyte ratio in pancreatic cancer:a metaanalysis[J].World J Gastroenterol,2015,21(9):2807-15.
[3]Yang X,Huang Y,Feng JF,et al.Prognostic significance of neutrophil-to-lymphocyte ratio in esophageal cancer:a metaanalysis[J].Onco Targets Ther,2015,8:789-94.
[4]Luigina G,Elisabetta M,Verena De A,et al.Prognostic value of preoperative neutrophils to lymphocytes ratio in patients resected for gastric cancer[J].Am J Surg,2015,209(2):333-7.
[5]Chen Q,Dai Z,Yin D,et al.Negative Impact of Preoperative Platelet-Lymphocyte Ratio on Outcome After Hepatic Resection for Intrahepatic Cholangio-carcinoma[J].Medicine(Baltimore),2015,94(13):e574.
[6]Kusumanto YH,Dam WA,Hospers GA,et al.Platelets and granulocytes,in particular the neutrophils,form important compartments for circulating vascular endothelial growth factor[J].Angiogenesis,2003,6(4):283-7.
[7]Chang H,Gao J,Xu BQ,et al.Haemoglobin,neutrophil to lymphocyte ratio and platelet count improve prognosis prediction of the TNM staging system in nasopharyngeal carcinoma:development and validation in 3,237 patients from a single institution[J].Clin Oncol(R Coll Radiol),2013,25(11):639-46.
[8]Jin Y,Ye X,He C,et al.Pretreatment neutrophil-to-lymphocyte ratio as predictor of survival for patients with metastatic nasopharyngeal carcinoma[J].Head Neck,2015,37(1):69-75.
[9]Jiang R,Zou X,Hu W,et al.The elevated pretreatment plateletto-lymphocyte ratio predicts poor outcome in nasopharyngeal carcinoma patients[J].Tumour Biol,2015,36(10):7775-87.
[10]Edge SB,Byrd DR,Compton CC,et al.AJCC cancer staging manual[M].7th.New York:Springer,2010.
[11]Eisenhauer EA,Therasse P,Bogaerts J,et al.New response evaluation criteria in solid tumours:Revised recist guideline(version 1.1)[J].Eur J Cancer,2009,45(2):228-47.
[12]Tsai YD,Wang CP,Chen CY,et al.Pretreatment circulating monocyte count associated with poor prognosis in patients with oral cavity cancer[J].Head Neck,2014,36(7):947-53.
[13]Torisu H,Ono M,Kiryu H,et al.Macrophage infiltration correlates with tumor stage and angiogenesis in human malignant melanoma:possible involvement of TNFalpha and IL-1alpha[J].Int J Cancer,2000,85(2):182-8.
[14]Varney ML,Olsen KJ,Mosley RL,et al.Paracrine regulation of vascular endothelial growth factor--a expression during macrophage-melanoma cell interaction:role of monocyte chemotactic protein-1 and macrophage colony-stimulating factor[J].J Interferon Cytokine Res,2005,25(11):674-83.
[15]Valero C,Pardo L,Lopez M,et al.Pretreatment count of peripheral neutrophils,monocytes,and lymphocytes as independent prognostic factor in patients with head and neck cancer[J].Head Neck,2017,39(2):219-26.
[16]Cerwenka A,Lanier LL.Natural killer cell memory in infection,inflammation and cancer[J].Nat Rev Immunol,2016,16(2):112-23.
[17]Wang D,DuBois RN.Immunosuppression associated with chronic inflammation in the tumor microenvironment[J].Carcinogenesis,2015,36(10):1085-93.
[18]Radziwon-Balicka A,Moncada de la Rosa C,Jurasz P.Plateletassociated angiogenesis regulating factors:a pharmacological perspective[J].Can J Physiol Pharmacol,2012,90(6):679-88.
[19]Takagi S,Takemoto A,Takami M,et al.Platelets promote osteosarcoma cell growth through activation of the plateletderived growth factor receptor-Akt signaling axis[J].Cancer Sci,2014,105(8):983-8.
[20]李晓惠,徐冰清,高劲,等.中性粒细胞与淋巴细胞比值对鼻咽癌放射敏感性及预后影响的研究[J].中华放射肿瘤学杂志,2016,25(5):432-6.[Li XH,Xu BQ,Gao J,et al.Influence of neutrophil-lymphocyte ratio on radiosensitivity and prognosis in patients with nasopharyngeal carcinoma[J].Zhonghua Fang She Zhong Liu Za Zhi,2016,25(5):432-6.]
[21]An X,Ding PR,Wang FH,et al.Elevated neutrophil to lymphocyte ratio predicts poor prognosis in nasopharyngeal carcinoma[J].Tumour Biol,2011,32(2):317-24.
[22]He JR,Shen GP,Ren ZF,et al.Pretreatment levels of peripheral neutrpphils and lymphocytes as independent prognostic factors in patients with nasopharyngeal carcinoma[J].Head Neck,2012,34(12):1769-76.
[23]Li JP,Chen SL,Liu XM,et al.A Novel Inflammation-Based Stage(ⅠStage)Predicts Overall Survival of Patients with Nasopharyngeal Carcinoma[J].Int J Mol Sci,2016,17(11).pii:E1900.
[24]Feng J.Induction Chronochemotherapy Plus Radiation Therapy for Nasopharyngeal Carcinoma:A Phase 2 Prospective Randomized Study[J].Inter J Radiation Oncol Biol Phys,2013,87(2Suppl):S448.