外周血中性粒细胞与淋巴细胞比值和血小板与淋巴细胞比值评估肝母细胞瘤患儿预后的价值

Prognostic Value of Peripheral Blood Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio in Assessing the Prognosis of Children with Hepatoblastoma

摘要: 肝母细胞瘤(hepatoblastoma, HB)是小儿最常见的肝脏恶性肿瘤，目的：探讨系统性炎症指标包括中性粒细胞/淋巴细胞比值(neutrophil-to-lymphocyte ratio, NLR)及血小板/淋巴细胞比值(platelet-to- lymphocyte ratio, PLR)与HB患儿预后生存的关系。方法：收集了2013年7月至2019年7月在重庆医科大学附属儿童医院肿瘤外科首次就诊并接受治疗的肝母细胞瘤患儿的临床及随访资料，通过ROC曲线计算出NLR及PLR的最大的约登指数(即临界值)，按照NLR及PLR的临界值进行分组，KM分析及log-rank检验计算生存率，多因素COX分析预后影响因素。结果：高NLR组(NLR > 2.12) 31例总体生存率为49.9% ± 6.6%，低NLR组(NLR 2.12) 162例总体生存率为88.2% ± 2.9%，差异具有统计学意义(P < 0.001)。高PLR组(PLR > 144.9) 109例总体生存率为66.3% ± 3.8%，低PLR组(PLR 144.9) 84例总体生存率为95.1% ± 3.1%，差异具有统计学意义(P < 0.001)。NLR > 2.12 (P = 0.008, HR = 2.522, 95% CI: 1.272~5.001)、PLR > 144.9 (P = 0.003, HR = 4.320, 95% CI: 1.639~11.383)及转移(P = 0.009, HR = 2.557, 95% CI: 1.265~5.169)是影响肝母细胞瘤生存的独立危险因素。结论：为了更全面的预测肿瘤患者的预后，可以增加NLR及PLR指标，用于辅助筛选高危的肝母细胞瘤患儿，指导临床医生调整治疗方案提高患儿预后生存情况。

Abstract: Hepatoblastoma (HB) is the most common malignant tumor of the liver in pediatric patients. Purpose: To investigate the relationship between systemic inflammatory indicators including neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) and prognostic survival in children with HB. Methods: Clinical and follow-up data of children with hepatoblastoma who were first treated in the Department of Oncology, Children’s Hospital of Chongqing Medical University from July 2013 to July 2019 were collected, and the maximum Yordon index (i.e., critical value) of NLR and PLR were calculated by ROC curve, grouped according to the critical values of NLR and PLR, KM analysis and log-rank test. The survival rate was calculated, and the prognostic influences were analyzed by multi-factor COX. Results: There were 31 cases in the high NLR group (NLR > 2.12) and 162 cases in the low NLR group (NLR 2.12), 109 cases in the high PLR group (PLR > 144.9) and 84 cases in the low PLR group (PLR 144.9); the overall survival rate in the high NLR group was 49.9% ± 6.6%, and the overall survival rate in the low The overall survival rate was 49.9% ± 6.6% in the high NLR group and 88.2% ± 2.9% in the low NLR group, with statistically significant differences (P < 0.001). The overall survival rates were 66.3% ± 3.8% in the high PLR group and 95.1% ± 3.1% in the low PLR group, with statistically significant differences (P < 0.001). NLR > 2.12 (P = 0.008, HR = 2.522, 95% CI: 1.272 - 5.001), PLR > 144.9 (P = 0.003, HR = 4.320, 95% CI: 1.639 - 11.383) and metastasis (P = 0.009, HR = 2.557, 95% CI: 1.265 - 5.169) were independent risk factors for hepatoblastoma survival. Conclusion: In order to more comprehensively predict the prognosis of tumor patients, NLR and PLR indicators can be added to assist in screening children with high-risk hepatoblastoma and to guide clinicians in adjusting treatment regimens to improve their prognostic survival.