Baseline neutrophil-lymphocyte ratio (≥2.8) as a prognostic factor for patients with locally advanced rectal cancer undergoing neoadjuvant chemoradiation.
Baseline neutrophil-lymphocyte ratio (≥2.8) as a prognostic factor for patients with locally advanced rectal cancer undergoing neoadjuvant chemoradiation.
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基线中性粒细胞-淋巴细胞比率（±2.8）作为接受新辅助放化疗的局部晚期直肠癌患者的预后因素
DOI：
10.1186/s13014-014-0295-2
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发表时间：
2014-12-18
期刊：
影响因子：
--
通讯作者：
Zhang Z
中科院分区：
文献类型：
--
作者：
Shen L;Zhang H;Liang L;Li G;Fan M;Wu Y;Zhu J;Zhang Z
中性粒细胞-淋巴细胞比率（NLR）已被提出作为全身性炎症反应的指标，并可预测某些癌症的临床结局，如头颈癌和胃癌。然而，这个比率的值在不同的癌症中是可变的。对于局部晚期直肠癌，NLR与生存率和放化疗反应之间关系的研究一直有限。回顾性分析2006 - 2011年在上海癌症中心连续199例接受新辅助放化疗的局部晚期直肠癌患者。病理结果评价肿瘤反应。记录基线总白细胞计数（WBC）和中性粒细胞、淋巴细胞、血小板计数。分析中性粒细胞-淋巴细胞比率（NLR）及其与总生存期（OS）、无病生存期（DFS）等临床结果的关系。通过ROC分析，发现基线NLR值可以很好地预测局部晚期直肠癌患者的预后。多因素分析发现，NLR≥2.8的临界值可作为OS降低的独立因素（HR, 2.123; 95% CI, 1.140-3.954; P = 0.018）。在单因素分析中，NLR≥2.8也与较差的DFS相关（HR, 1.662; 95% CI, 1.037 ~ 2.664; P = 0.035），但在多因素分析中，NLR≥2.8与较差的DFS相关（HR, 1.363; 95% CI, 0.840 ~ 2.214; P = 0.210）。未观察到NLR平均值与新辅助放化疗反应的显著相关性。ypt3 -2 N+组NLR均值为2.68±1.38，ypT3-4/N+组NLR均值为2.77±1.38，差异均无统计学意义（P = 0.703）。TRG 0-1组NLR均值为2.68±1.42，TRG 2-3组NLR均值为2.82±1.33，差异无统计学意义（P = 0.873）。除了新辅助治疗后的肿瘤反应外，升高的基线NLR是OS的一个有价值且容易获得的预后因素。基线NLR可能是局部晚期直肠癌患者分层和制定治疗决策的有用候选因素。
The neutrophil-lymphocyte ratio (NLR) has been proposed as an indicator of systemic inflammatory response and may predict the clinical outcome in some cancers, such as head and neck cancer and gastric cancer. However, the value of this ratio is variable in different cancers. Studies of the relationship between NLR and both survival and response to chemoradiation have been limited with respect to locally advanced rectal cancer. From 2006 to 2011, 199 consecutive locally advanced rectal cancer patients who were treated with neoadjuvant chemoradiation in the Shanghai Cancer Center were enrolled and analysed retrospectively. Tumor response was evaluated by pathological findings. The baseline total white blood cell count (WBC) and the neutrophil, lymphocyte, platelet counts were recorded. The neutrophil-lymphocyte ratio (NLR) and the relationship with clinical outcomes such as overall survival (OS) and disease-free survival (DFS) was analyzed. With ROC analysis, the baseline NLR value was found to significantly predict prognosis in terms of OS well in locally advanced rectal cancer patients. A multivariate analysis identified that a cut-off value of NLR ≥ 2.8 could be used as an independent factor to indicate decreased OS (HR, 2.123; 95% CI, 1.140-3.954; P = 0.018). NLR ≥ 2.8 was also associated with worse DFS in univariate analysis (HR, 1.662; 95% CI, 1.037-2.664; P = 0.035), though it was not significant in the multivariate analysis (HR, 1.363; 95% CI, 0.840-2.214; P = 0.210). There was no observed significant correlation of mean value of NLR to the response to neoadjuvant chemoradiation. The mean NLR in the ypT0-2 N0 group was 2.68 ± 1.38, and it was 2.77 ± 1.38 in the ypT3-4/N+ group, with no statistical significance (P = 0.703). The mean NLR in the TRG 0–1 group was 2.68 ± 1.42, and it was 2.82 ± 1.33 in the TRG 2–3 group with no statistical significance (P = 0.873). An elevated baseline NLR is a valuable and easily available prognostic factor for OS in addition to tumor response after neoadjuvant therapy. Baseline NLR could be a useful candidate factor for stratifying patients and making treatment decisions in locally advanced rectal cancer.
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