术前血淋比、粒淋比及血脂水平与舌癌TNM分期关系的临床研究

Clinical Study on Preoperative Neutrophil Lymphocyte Ratio, Platelet Lymphocyte Ratio, Serum Lipid Level and TNM Staging Relationships of Tongue Carcinoma

摘要: 背景与目的：目前已证实术前全身炎症反应标记物粒淋比例(Neutrophil Lymphocyte Ratio, NLR)和血淋比例(Platelet Lymphocyte Ratio, PLR)与多种肿瘤的TNM分期及预后有密切关系，而NLR、PLR和血脂水平与舌癌TNM分期及患者预后关系的研究很少。该研究的目的是探讨舌癌患者术前全身炎症反应标记物NLR、PLR和血脂水平与舌癌TNM分期的相关性。资料和方法：回顾性分析2009~2011年山东大学齐鲁医院口腔科手术治疗的54例舌癌患者的临床病例资料。病例资料包括患者的基本临床特征(性别、年龄)，术后肿瘤情况(术后病理TNM分期、病变的位置、肿瘤切缘情况、分化程度、淋巴结转移比例和辅助治疗史)以及术前2~7天内血常规检查结果(白细胞绝对值、中性粒细胞绝对值、淋巴细胞绝对值和血小板绝对值和血脂水平)。粒淋比例(NLR)定义为中性粒细胞绝对值与淋巴细胞绝对值之比，血淋比例(PLR)定义为血小板绝对值与淋巴细胞绝对值之比。NLR和PLR与肿瘤TNM分期的相关性采用Spearman秩相关检验和独立样本t检验分别分析，血脂与肿瘤TNM分期关系采用t检验，P < 0.05认为差异有统计学意义。获得的数据均釆用SPSS 17.0统计包进行统计学分析。结果：54例舌癌患者当中，鳞状细胞癌38例，粘液表皮样癌3例，腺样囊性癌2例，腺泡细胞癌及肌上皮癌各一例，其中男性患者36例，女性患者18例。TNM分期当中T1患者16例，T2患者20例，T3患者4例，T4患者9例；无淋巴结转移(N0)患者26例，N1患者18例，N2患者10例；而M1患者2例，其余皆为M0。根据资料计算各患者NLR、PLR值，采用Spearman秩相关检验法进行检验，NLR以及PLR与肿瘤TNM分期、肿瘤大小T、淋巴结转移N均没有显著的相关关系(P_NLR&T = 0.552 > 0.05; P_NLR&N = 0.297 > 0.05; P_NLR&TNM = 0.42 > 0.05; P_PLR&T = 0.149 > 0.05; P_PLR&N = 0.062 > 0.05; P_PLR&TNM = 0.127 > 0.05)。其中PLR与淋巴结转移分类N的P值为0.062，接近0.05。不同组织学分类的患者TC、HDL、LDL、TG水平差异均无统计学意义(P > 0.05)。结论：1) 粒淋比与患者的临床及病理特征之间无明显相关性；2) 血淋比与患者的临床及病理特征之间无明显相关性；3) 血脂正异常与患者的临床及病理特征之间无明显相关性。

Abstract: Background & Purpose: Currently, preoperative neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) have been proven closely related to various cancer TNM staging and prognosis. However, correlations between NLR, PLR, blood lipid level and tongue carcinoma TNM staging were less studied. The aim of this study was to investigate correlations between preoperative NLR, PLR, serum lipid level and TNM staging of tongue carcinoma. Methods: Fifty-four cases of tongue carcinoma were retrospectively analyzed between 2009 and 2011 in Department of Oral & Maxillofacial Surgery of Qilu Hospital Shandong University. Basic clinical characteristics of patients (sex, age), postoperative pathologic lesions of TNM staging and preoperative routine blood tests results within 2~7 days (absolute neutrophil white blood cells, lymphocyte absolute value and platelet and blood lipid levels) were collected. Neutrophil lymphocyte ratio (NLR) was defined as the ratio of absolute value of absolute neutrophils and lymphocytes, and platelet lymphocyte ratio (PLR) was the ratio of absolute value of platelet and lymphocyte absolute value. Spearman rank correlation test was applied to estimate the correlation between NLR, PLR and cancer TNM staging, while independent sample t test was applied to estimate the correlation between serum lipid level and cancer TNM staging. The obtained data were analyzed by SPSS 17.0 software package, and P < 0.05 demonstrated the significance. Results: Among 54 cases of tongue carcinoma, squamous cell carcinoma accounted 38 cases, mucoepidermoid carcinoma 3 cases, adenoidcystic carcinoma 2 cases, acinic cell carcinoma 1 case and myoepithelial carcinoma 1 case, with 36 cases of male patients and 18 cases of female patients, 16 cases of TNM stages T1, 20 cases of T2, 4 cases of T3 and 9 cases of T4. 26 cases had no lymph node metastases (N0), 18 cases with N1 and 10 cases with N2, 2 cases of M1, while the others were all for M0. NLR and PLR were calculated by collected data, and Spearman rank correlation tests were applied to test NLR, PLR and cancer TNM staging, tumor size, lymph node metastasis. None had a significant correlation (P_NLR&T = 0.552 > 0.05; P_NLR&N = 0.297 > 0.05; P_NLR&TNM = 0.42 > 0.05; P_PLR&T = 0.149 > 0.05; P_PLR&N = 0.062 > 0.05; P_PLR&TNM = 0.127 > 0.05). And also, there was no significant difference between different histological classification of patients and TC, HDL, LDL, TG levels (P > 0. 05). Conclusions: 1) There’s no significant correlation between neutrophil lymphocyte ratio (NLR) and TNM Staging of Tongue Carcinoma; 2) There’s no significant correlation between platelet lymphocyte ratio (PLR) and TNM Staging of Tongue Carcinoma; 3) There’s no significant correlation between serum lipid level and TNM Staging of Tongue Carcinoma.