外周血中性粒细胞与淋巴细胞比值对初治多发性骨髓瘤患者预后评估的价值
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摘要
目的:探讨外周血中性粒细胞/淋巴细胞比值(neutrophil-lymphocyte ratio,NLR)与初治多发性骨髓瘤(multipe myeloma,MM)患者临床病理特征的相关性,以及在预后中的预测价值。方法:回顾分析我院1998年1月至2017年8月收治的146例初治MM患者的临床病理特征、治疗效果、生存情况及预后。按中位NLR将患者分为低NLR组和高NLR组,观察NLR与患者临床病理特征及预后之间的关系。生存分析采用Kaplan-Meier法,log-rank检验进行预后的单因素分析,COX比例风险模型进行预后的多因素分析。结果:NLR与乳酸脱氢酶、白蛋白、β2微球蛋白和溶骨性病变数目相关(P<0.05)。单因素分析结果显示β2微球蛋白(P=0.014)、溶骨性病变数目(P=0.022)以及接受治疗前外周血NLR(P=0.005)是影响预后的相关因素。COX比例风险回归模型的分析结果显示仅治疗前NLR(P=0.011)是初治MM患者独立的预后不良因素。结论:NLR作为一种简单、经济、可重复检测的全身炎性反应指标,对初治MM患者的预后评估具有一定的临床应用价值;治疗前外周血NLR值越高,提示患者的预后越差。
Objective:To investigate the correlation between pre-treatment neutrophil-lymphocyte ratio(NLR)and clinicopathological features,as well as the effect of NLR on the prognosis of newly-diagnosed multiple myeloma(MM)patients.Methods:Retrospective analysis was performed for 146 cases histologically confirmed of newly-diagnosed MM patients from our hospital between January 1998 and August 2017.All patients were classified into two groups based on the median value,an NLR of 3.0 or more were classified as high NLR individuals,patients were followed up regularly.Univariate and multivariate analysis was produced on the clinicopathological factors affecting survival.Results:NLR was associated with LDH,albumin,β2-microglobulin level and the number of osteolytic lesions(P<0.05).Univariate analysis showed that β2-microglobulin level(P=0.014),the number of osteolytic lesions(P=0.022)and NLR(P=0.005)value were associated with the prognosis.Multivariate analysis identified only NLR value(P=0.011)were the independent poor prognostic factor.Conclusion:Pretreatment NLR is an easily measured,reproducible and inexpensive marker of systemic inflammation and thus shows a prognostic and predictive value in prognosis evaluation for patients newly-diagnosed MM patients. An elevated blood pre-treatment NLR indicates poor prognosis.
Objective:To investigate the correlation between pre-treatment neutrophil-lymphocyte ratio(NLR)and clinicopathological features,as well as the effect of NLR on the prognosis of newly-diagnosed multiple myeloma(MM)patients.Methods:Retrospective analysis was performed for 146 cases histologically confirmed of newly-diagnosed MM patients from our hospital between January 1998 and August 2017.All patients were classified into two groups based on the median value,an NLR of 3.0 or more were classified as high NLR individuals,patients were followed up regularly.Univariate and multivariate analysis was produced on the clinicopathological factors affecting survival.Results:NLR was associated with LDH,albumin,β2-microglobulin level and the number of osteolytic lesions(P<0.05).Univariate analysis showed that β2-microglobulin level(P=0.014),the number of osteolytic lesions(P=0.022)and NLR(P=0.005)value were associated with the prognosis.Multivariate analysis identified only NLR value(P=0.011)were the independent poor prognostic factor.Conclusion:Pretreatment NLR is an easily measured,reproducible and inexpensive marker of systemic inflammation and thus shows a prognostic and predictive value in prognosis evaluation for patients newly-diagnosed MM patients. An elevated blood pre-treatment NLR indicates poor prognosis.
引文
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[12] Wang Li,Wu Haiying,Zhang Mengyang,et al.Inducible nitric oxide synthase activity correlates with lymphangiogenesis and vascular endothelial growth factor-C expression in cervical cancer[J].Modern Oncology,2017,25(13):2122-2126.[王莉,武海英,张梦阳,等.宫颈癌中iNOS的表达与肿瘤新生淋巴管及VEGF-C的关系[J].现代肿瘤医学,2017,25(13):2122-2126.]
[2] Muzes G,Sipos F.Inflammasome,inflammation and cancer:An interrelated pathobiological triad[J].Curr Drug Targets,2015,16(3):249-257.
[3] Balkwill F,Mantovani A.Inflammation and cancer:Back to Virchow[J]?Lancet,2001,357(9255):539-545.
[4] International Myeloma Working Group.Criteria for the classification of monoclonal gammopathies,multiple myeloma and related disorders:A report of the International Myeloma Working Group[J].Br J Haematol,2003,121(5):749-757.
[5] Blade J,Samson D,Reece D,et al.Criteria for evaluating disease response and progression in patients with multiple myeloma treated by high-dose therapy and haemopoietic stem cell transplantation.Myeloma Subcommittee of the EBMT.European Group for Blood and Marrow Transplant[J].Br J Haematol,1998,102(5):1115-1123.
[6] Krenn-Pilko S,Langsenlehner U,Thurner EM,et al.The elevated preoperative platelet-to-lymphocyte ratio predicts poor prognosis in breast cancer patients[J].Br J Cancer,2014,110(10):2524-2530.
[7] Wu G,Yao Y,Bai C,et al.Combination of platelet to lymphocyte ratio and neutrophil to lymphocyte ratio is a useful prognostic factor in advanced non-small cell lung cancer patients[J].Thorac Cancer,2015,6(3):275-287.
[8] Wang L,Liang D,Xu X,et al.The prognostic value of neutrophil to lymphocyte and platelet to lymphocyte ratios for patients with lung cancer[J].Oncol Lett,2017,14(6):6449-6456.
[9] Gao Y,Wang WJ,Zhi Q,et al.Neutrophil/lymphocyte ratio is a more sensitive systemic inflammatory response biomarker than platelet/lymphocyte ratio in the prognosis evaluation of unresectable pancreatic cancer[J].Oncotarget,2017,8(51):88835-88844.
[10] Jung J,Lee H,Yun T,et al.Prognostic role of the neutrophil-to-lymphocyte ratio in patients with primary central nervous system lymphoma[J].Oncotarget,2017,8(43):74975-74986.
[11] Yu Shasha,Meng Yongbin,Chen Zhe,et al.Effect of transcatheter arterial chemoembolization on NLR for patients with primary liver cancer[J].Modern Oncology,2017,25(09):1426-1429.[郁沙莎,孟永斌,陈喆,等.肝动脉化疗栓塞术对原发性肝癌患者中性粒细胞与淋巴细胞比值的影响[J].现代肿瘤医学,2017,25(09):1426-1429.]
[12] Wang Li,Wu Haiying,Zhang Mengyang,et al.Inducible nitric oxide synthase activity correlates with lymphangiogenesis and vascular endothelial growth factor-C expression in cervical cancer[J].Modern Oncology,2017,25(13):2122-2126.[王莉,武海英,张梦阳,等.宫颈癌中iNOS的表达与肿瘤新生淋巴管及VEGF-C的关系[J].现代肿瘤医学,2017,25(13):2122-2126.]