侵袭性分化型甲状腺癌外周血中性粒细胞/淋巴细胞比值的临床意义
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摘要
目的检测侵袭性分化型甲状腺癌患者术前中性粒细胞与淋巴细胞比值(neutrophil-lymphocyte ratio,NLR),探讨用NLR指标评估局部晚期甲状腺癌的临床意义。方法采用1:1配对病例对照研究设计法,共收集侵袭性分化型甲状腺癌(侵袭组)和微小乳头状癌(非侵袭组)各40例患者,记录并计算术前NLR及C反应蛋白数值,比较侵袭组和非侵袭组之间的NLR和C反应蛋白的差异,以ROC曲线评价各指标对侵袭性分化型甲状腺癌的临床意义。结果侵袭组NLR为2.61±1.15,显著高于非侵袭组1.76±0.84,两组之间比较差异有统计学意义(F=5.016,P=0. 034),而两组之间C反应蛋白差异无统计学意义(F=2.136,P=0.158)。NLR对侵袭性分化型甲状腺癌患者诊断的曲线下面积为0.766,NLR诊断侵袭性分化型甲状腺癌的最佳临界值为1.95,敏感度为77.3%,特异度为69.1%。结论 NLR可以作为评价甲状腺癌患者局部侵袭的指标之一,NLR值越高,局部侵袭风险越大。
OBJECTIVE To investigate the clinical significance of neutrophil-to-lymphocyte ratio(NLR) in patients with invasive well-differentiated thyroid cancer.METHODS Using 1:1 matched case-control study, 80 patients of invasive well-differentiated thyroid cancer(invasion group) and papillary thyroid micro-carcinoma(no-invasion group) were recruited and studied. The NLR and C-reactive protein were compared among different groups, and their diagnostic values were evaluated using the area under the receiver-operating characteristic(ROC)curve. RESULTS The NLR(F =5.016, P =0.034), but not C-reactive protein(F =2.136, P =0.158), had significant differece between the two groups. The NLR, 2.61±1.15 in invasion group, was signif icantly higher than that in no-invasion group(P <0.05). The areas under the curve of NLR for the diagnosis of invasive well-differentiated thyroid cancer were 0.766; the optimal cut-off value of NLR was 1.95 for the diagnosis with a sensitivity of 77.3% and a speci?city of 69.1%. CONCLUSION Preoperative NLR may be a prognostic marker in patients with thyroid cancer. High NLR is a risk factors in?uencing extra-thyroidal invasion of well-differentiated thyroid cancer.
OBJECTIVE To investigate the clinical significance of neutrophil-to-lymphocyte ratio(NLR) in patients with invasive well-differentiated thyroid cancer.METHODS Using 1:1 matched case-control study, 80 patients of invasive well-differentiated thyroid cancer(invasion group) and papillary thyroid micro-carcinoma(no-invasion group) were recruited and studied. The NLR and C-reactive protein were compared among different groups, and their diagnostic values were evaluated using the area under the receiver-operating characteristic(ROC)curve. RESULTS The NLR(F =5.016, P =0.034), but not C-reactive protein(F =2.136, P =0.158), had significant differece between the two groups. The NLR, 2.61±1.15 in invasion group, was signif icantly higher than that in no-invasion group(P <0.05). The areas under the curve of NLR for the diagnosis of invasive well-differentiated thyroid cancer were 0.766; the optimal cut-off value of NLR was 1.95 for the diagnosis with a sensitivity of 77.3% and a speci?city of 69.1%. CONCLUSION Preoperative NLR may be a prognostic marker in patients with thyroid cancer. High NLR is a risk factors in?uencing extra-thyroidal invasion of well-differentiated thyroid cancer.
引文
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[8] Li MX,Liu XM,Zhang XF,et al. Prognostic role of neutrophilto-lymphocyte ratio in colorectal cancer:a systematic review and meta-analysis. Int J Cancer, 2014, 134(10):2403-2413.
[9] Mano Y, Shirabe K, Yamashita Y, et al. Preoperative neutrophilto-lymphocyte ratio is a predictor of survival after hepatectomy for hepatocellular carcinoma:a retrospective analysis. Ann Surg,2013, 258(2):301-305-
[10] Ferroni P,Roselli M,Buonomo OC,et al. Prognostic significanceof neutrophil-to-lymphocyte ratio in the framework of the 8th TNM edition for breast cancer. Anticancer Res,2018,38(8):4705-4712.
[11] Pichler M, Hutterer GC, Stoeckigt C, et al. Validation of the pre.treatment neutrophil-lymphocyte ratio as a prognostic factor in a large European cohort of renal cell carcinoma patients. Br J Cancer,2013, 108(4):901-907.
[12] Seretis C,Gourgiotis S,Gemenetzis G,et al. The significance of neutrophil/lymphocyte ratio as a possible marker of underlying papillary microcarcinomas in thyroidal goiters:a pilot study. Am J Surg,2013, 205(6):691-696.
[13]林帅,高砚春·术前外周血中性粒细胞/淋巴细胞比值对甲状腺癌预后的影响·临床肿瘤学杂志,2017, 22(11):1017-1020-
[14]马恒,王晓雷.术前中性粒细胞与淋巴细胞比值对甲状腺乳头状癌患者术后无复发生存的预测价值.山东医药,2015, 55(16):15-17.
[15] Manatakis DK, Tseleni-Balafouta S, Balalis D, et al.Association of baseline neutrophil-to-lymphocyte ratio with clinicopathological characteristics of papillary thyroid carcinoma.Int J Endocrinol, 2017, 2017(5):847-852.
[16] Cho JS, Park MH, Ryu YJ, et al. The neutrophil to lymphocyte ratio can discriminate anaplastic thyroid cancer against poorly or well differentiated cancer. Ann Surg Treat Res, 2015, 88(4):187-192.
[17] Dumitru CA, Lang S, Brandau S. Modulation of neutrophil granulocytes in the tumor microenvironment:mechanisms and consequences for tumor progression. Semin Cancer Biol, 2013,23(3):141-148-
[18] Sylman JL, Mitrugno A, Atallah M, et al. The predictive value of inflammation-related peripheral blood measurements in cancer staging and prognosis. Front Oncol, 2018, 8(5):78-89.
[2] Hay ID, Mcconahey WM, Goellner JR. Managing patients with papillary thyroid carcinoma:insights gained from the Mayo Clinic's experience of treating 2,512 consecutive patients during1940 through 2000. Trans Am Clin Climatol Assoc, 2002,113(s6):241-260.
[3] Coussens LM, Werb Z-Inflammation and cancer. Nature,2002,420(6917):860-867-
[4] Mantovani A, Allavena P, Sica A, et al. Cancer-related inflammation. Nature,2008, 454(7203):436-444.
[5] Guthrie GJ, Charles KA, Roxburgh CS, et al. The systemic inflammation-based neutrophil-lymphocyte ratio:experience in patients with cancer. Crit Rev Oncol Hematol.2013, 88(1):218-230-
[6] Tuttle RM, Haugen B, Perrier ND. Updated American Joint Committee on Cancer/Tumor-Node-Metastasis staging system for differentiated and anaplastic thyroid cancer(eighth edition):what changed and why? Thyroid,2017, 27(6):751-756.
[7] Sarraf KM, Belcher E, Raevsky E, et al-Neutrophil/lymphocyte ratio and its association with survival after complete resection in non-small cell lung cancer. J Thorac Cardiovasc Surg, 2009,137(2):425-428-
[8] Li MX,Liu XM,Zhang XF,et al. Prognostic role of neutrophilto-lymphocyte ratio in colorectal cancer:a systematic review and meta-analysis. Int J Cancer, 2014, 134(10):2403-2413.
[9] Mano Y, Shirabe K, Yamashita Y, et al. Preoperative neutrophilto-lymphocyte ratio is a predictor of survival after hepatectomy for hepatocellular carcinoma:a retrospective analysis. Ann Surg,2013, 258(2):301-305-
[10] Ferroni P,Roselli M,Buonomo OC,et al. Prognostic significanceof neutrophil-to-lymphocyte ratio in the framework of the 8th TNM edition for breast cancer. Anticancer Res,2018,38(8):4705-4712.
[11] Pichler M, Hutterer GC, Stoeckigt C, et al. Validation of the pre.treatment neutrophil-lymphocyte ratio as a prognostic factor in a large European cohort of renal cell carcinoma patients. Br J Cancer,2013, 108(4):901-907.
[12] Seretis C,Gourgiotis S,Gemenetzis G,et al. The significance of neutrophil/lymphocyte ratio as a possible marker of underlying papillary microcarcinomas in thyroidal goiters:a pilot study. Am J Surg,2013, 205(6):691-696.
[13]林帅,高砚春·术前外周血中性粒细胞/淋巴细胞比值对甲状腺癌预后的影响·临床肿瘤学杂志,2017, 22(11):1017-1020-
[14]马恒,王晓雷.术前中性粒细胞与淋巴细胞比值对甲状腺乳头状癌患者术后无复发生存的预测价值.山东医药,2015, 55(16):15-17.
[15] Manatakis DK, Tseleni-Balafouta S, Balalis D, et al.Association of baseline neutrophil-to-lymphocyte ratio with clinicopathological characteristics of papillary thyroid carcinoma.Int J Endocrinol, 2017, 2017(5):847-852.
[16] Cho JS, Park MH, Ryu YJ, et al. The neutrophil to lymphocyte ratio can discriminate anaplastic thyroid cancer against poorly or well differentiated cancer. Ann Surg Treat Res, 2015, 88(4):187-192.
[17] Dumitru CA, Lang S, Brandau S. Modulation of neutrophil granulocytes in the tumor microenvironment:mechanisms and consequences for tumor progression. Semin Cancer Biol, 2013,23(3):141-148-
[18] Sylman JL, Mitrugno A, Atallah M, et al. The predictive value of inflammation-related peripheral blood measurements in cancer staging and prognosis. Front Oncol, 2018, 8(5):78-89.