外周血中性粒细胞/淋巴细胞比值在评估胃肠道神经内分泌肿瘤患者预后中的价值
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摘要
目的评估外周血中性粒细胞/淋巴细胞比值(NLR)在胃肠道神经内分泌肿瘤(GI-NENs)患者预后中的价值。方法选择2011年6月至2018年6月西南医科大学附属医院收治的55例经病理诊断为GI-NENs的患者为研究对象,根据受试者工作特征曲线确定出NLR的最佳截断值,分为高NLR组和低NLR组,比较不同组间的临床特征及总生存率。结果低NLR组与高NLR组GI-NENs患者的1年生存率分别为93. 4%和69. 8%,3年生存率分别为93. 4%和49. 8%。与低NLR组相比,高NLR组患者的肿瘤直径更大、病理分级越差,淋巴结转移、远处转移率越高(P <0. 05)。多因素分析结果显示,NLR> 2. 8、肿瘤直径、淋巴结转移、远处转移是影响GI-NENs患者生存的危险因素(P <0. 05)。结论对于GI-NENs患者,高NLR常提示病理分级不良、肿瘤直径大、淋巴结和远处转移率高,NLR有望作为GI-NENs预后的标志物之一,对GI-NENs预后有一定的评估价值。
Objective To assess the value of neutrophil-to-lymphocyte ratio( NLR) in peripheral blood for the prognosis of patients with gastrointestinal neuroendocrine neoplasms( GI-NENs). Methods A total of 55 patients with pathological diagnosis of GI-NENs admitted to the Affiliated Hospital of Southwest Medical University from Jun. 2011 to Jun. 2018 were included in the study. The optimal cut-off value of NLR was determined according to the receiver operating characteristic curve,and the patients were divided into a high NLR group and a low NLR group accordingly to compare the clinical characteristics and overall survival rate. Results The 1-year survival rates of patients with low NLR and high NLR GI-NENs were 93. 4% and 69. 8%; The 3-year survival rates were 93. 4% and 49. 8%. Compared with the low NLR group,patients in the high NLR group had larger tumor diameter,poorer pathological grading,and higher rates of lymph node metastasis and distant metastasis( P < 0. 05). Multivariate analysis showed that NLR > 2. 8,tumor size,lymph node metastasis,and distant metastasis were independent risk factors for the survival of GI-NENs patients( P < 0. 05).Conclusion For patients with GI-NENs,high NLR often indicates poor pathological grading,large tumor diameter,high lymph node and distant metastasis rate. NLR is expected to be one of the prognostic markers of GI-NENs and has certain assessment value for the prognosis of GI-NENs.
Objective To assess the value of neutrophil-to-lymphocyte ratio( NLR) in peripheral blood for the prognosis of patients with gastrointestinal neuroendocrine neoplasms( GI-NENs). Methods A total of 55 patients with pathological diagnosis of GI-NENs admitted to the Affiliated Hospital of Southwest Medical University from Jun. 2011 to Jun. 2018 were included in the study. The optimal cut-off value of NLR was determined according to the receiver operating characteristic curve,and the patients were divided into a high NLR group and a low NLR group accordingly to compare the clinical characteristics and overall survival rate. Results The 1-year survival rates of patients with low NLR and high NLR GI-NENs were 93. 4% and 69. 8%; The 3-year survival rates were 93. 4% and 49. 8%. Compared with the low NLR group,patients in the high NLR group had larger tumor diameter,poorer pathological grading,and higher rates of lymph node metastasis and distant metastasis( P < 0. 05). Multivariate analysis showed that NLR > 2. 8,tumor size,lymph node metastasis,and distant metastasis were independent risk factors for the survival of GI-NENs patients( P < 0. 05).Conclusion For patients with GI-NENs,high NLR often indicates poor pathological grading,large tumor diameter,high lymph node and distant metastasis rate. NLR is expected to be one of the prognostic markers of GI-NENs and has certain assessment value for the prognosis of GI-NENs.
引文
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[22]刘欢,陈念.胃肠胰神经内分泌肿瘤的内镜下诊治与预后[J].现代仪器与医疗,2018,24(2):91-93.
[23]尹小平,刘来蓬,严海冬,等.术前外周血中性粒细胞与淋巴细胞比对结直肠癌预后的评估价值的Meta分析[J].临床外科杂志,2018,26(7):538-541.
[2]Singh S,Asa SL,Dey C,et al.Diagnosis and management of gastrointestinal neuroendocrine tumors:An evidence-based Canadian consensus[J].Cancer Treat Rev,2016,47:32-45.
[3]Fendrich V,Bartsch DK.Surgical treatment of gastrointestinal neuroendocrine tumors[J].Langenbecks Arch Surg,2011,396(3):299-311.
[4]Castano JP,Sundin A,Maecke HR,et al.Gastrointestinal neuroendocrine tumors(NETs):New diagnostic and therapeutic challenges[J].Cancer Metastasis Rev,2014,33(1):353-359.
[5]Grivennikov SI,Greten FR,Karin M.Immunity,inflammation,and cancer[J].Cell,2010,140(6):883-899.
[6]童淑雅,王迪,陈佳丽,等.中性粒细胞与淋巴细胞比值与肿瘤预后的关系[J].现代肿瘤医学,2018,26(22):3701-3704.
[7]刘伟,黄景昊,赵跃,等.术前外周血中性粒细胞与淋巴细胞比值对结肠癌患者预后的影响[J].广西医学,2018,40(18):2137-2140.
[8]Oberg KE.Gastrointestinal neuroendocrine tumors[J].Ann Oncol,2010,21 Suppl 7:vii72-80.
[9]Lawrence B,Gustafsson BI,Chan A,et al.The epidemiology of gastroenteropancreatic neuroendocrine tumors[J].Endocrinol Metab Clin North Am,2011,40(1):1-18,vii.
[10]Broder MS,Cai B,Chang E,et al.Epidemiology of gastrointestinal neuroendocrine tumors in a us commercially insured population[J].Endocr Pract,2017,23(10):1210-1216.
[11]Niederle MB,Hackl M,Kaserer K,et al.Gastroenteropancreatic neuroendocrine tumours:The current incidence and staging based on the WHO and European Neuroendocrine Tumour Society classification:An analysis based on prospectively collected parameters[J].Endocr Relat Cancer,2010,17(4):909-918.
[12]O'Toole D,Kianmanesh R,Caplin M.ENETS 2016 Consensus Guidelines for the Management of Patients with Digestive Neuroendocrine Tumors:An Update[J].Neuroendocrinology,2016,103(2):117-118.
[13]Limaye AR,Clark V,Soldevila-Pico C,et al.Neutrophil-lymphocyte ratio predicts overall and recurrence-free survival after liver transplantation for hepatocellular carcinoma[J].Hepato Res,2013,43(7):757-764.
[14]Arima K,Okabe H,Hashimoto D,et al.Neutrophil-to-lymphocyte ratio predicts metachronous liver metastasis of pancreatic neuroendocrine tumors[J].Int J Oncol,2017,22(4):734-739.
[15]Cavallo F,De Giovanni C,Nanni P,et al.2011:The immune hallmarks of cancer[J].Cancer Immunol Immunother,2011,60(3):319-326.
[16]Gregory AD,Houghton AM.Tumor-associated neutrophils:New targets for cancer therapy[J].Cancer Res,2011,71(7):2411-2416.
[17]Boffetta P.Exploring a cancer biomarker:The example of C-reactive protein[J].J Natl Cancer Inst,2010,102(3):142-143.
[18]Mc Millan DC.The systemic inflammation-based Glasgow Prognostic Score:A decade of experience in patients with cancer[J].Cancer Treat Rev,2013,39(5):534-540.
[19]Chiang SF,Hung HY,Tang R,et al.Can neutrophil-to-lymphocyte ratio predict the survival of colorectal cancer patients who have received curative surgeryelectively?[J].Int J Colorectal Dis,2012,27(10):1347-1357.
[20]Stotz M,Gerger A,Eisner F,et al.Increased neutrophil-lymphocyte ratio is a poor prognostic factor in patients with primary operable and inoperable pancreatic cancer[J].Br J Cancer,2013,109(2):416-421.
[21]Grivennikov SI,Karin M.Dangerous liaisons:STAT3 and NF-kappaB collaboration and crosstalk in cancer[J].Cytokine Growth Factor Rev,2010,21(1):11-19.
[22]刘欢,陈念.胃肠胰神经内分泌肿瘤的内镜下诊治与预后[J].现代仪器与医疗,2018,24(2):91-93.
[23]尹小平,刘来蓬,严海冬,等.术前外周血中性粒细胞与淋巴细胞比对结直肠癌预后的评估价值的Meta分析[J].临床外科杂志,2018,26(7):538-541.