术前/术后中性粒细胞–淋巴细胞比值对非小细胞肺癌预后的预测价值

Predictive Value of Preoperative plus Postoperative Neutrophil-Lymphocyte Ratio for Prognosis of Non-Small Cell Lung Cancer

摘要: 目的：探讨术前/术后中性粒细胞–淋巴细胞数比值(PP-NLR)在非小细胞肺癌(NSCLC)预后评估中的价值。方法：回顾性选择2016年1月至2018年12月就诊于青岛大学附属医院并接受根治性手术的总共126例NSCLC患者的临床资料，通过ROC曲线计算术前和术后NLR的最佳截断值，升高赋值为1，反之则为0，PP-NLR定义为术前NLR和术后NLR赋值之和，通过Kaplan-Meier法进行生存分析并绘制不同PP-NLR分组的生存曲线，Log-rank检验进行组间差异性对比。卡方检验分析PP-NLR评分与临床病理特征之间的相关性，Cox风险比例模型进行多因素分析。结果：通过ROC曲线计算最大约登指数确定术前和术后NLR的最佳截断值分别为1.64 (敏感度0.810，特异度0.746)和2.05 (敏感度0.540，特异度0.714)。通过生存分析显示，不同PP-NLR分组的患者生存率存在统计学差异(P < 0.05)。对比不同PP-NLR分组的临床病理资料显示，PP-NLR评分水平与吸烟、T分期有关(均P < 0.05)。单因素分析显示，空腹血糖、T分期、尿酸、PP-NLR水平与NSCLC患者预后有关(均P < 0.05)，多因素COX分析显示PP-NLR、尿酸为影响患者预后的独立危险因素。结论：PP-NLR评分是手术切除的NSCLC患者的独立预后指标，有助于帮助临床医师对患者进行风险分层，筛选高危患者，提供更有效的临床决策指导。

Abstract: Objective: To explore the value of preoperative/postoperative neutrophil to lymphocyte ratio (PP-NLR) in the prognostic evaluation of non-small cell lung cancer (NSCLC). Methods: The clinical data of 126 patients with NSCLC who were treated in the Affiliated Hospital of Qingdao University from January 2016 to December 2018 and underwent radical surgery were retrospectively selected. The optimal cut-off value of preoperative and postoperative NLR was calculated by the ROC curve, and the increased assigned value was 1, otherwise it was 0. PP-NLR was defined as the sum of pre-operative NLR and postoperative NLR assigned values, and survival analysis was performed by Kaplan-Meier method and survival curves of different PP-NLR groups were drawn, Log-rank test was used to compare the differences between groups. Chi-square test was used to analyze the correla-tion between PP-NLR score and clinicopathological characteristics, and Cox risk proportional model was used for multifactor analysis. Results: The best cutoff values of NLR before and after operation were 1.64 (sensitivity 0.810, specificity 0.746) and 2.05 (sensitivity 0.540, specificity 0.714), re-spectively. The survival analysis showed that the survival rate of patients in different PP-NLR groups was statistically different (P < 0.05). Comparing the clinical pathological data of different PP-NLR groups, the PP-NLR score level was related to smoking and T stage (all P < 0.05). Single fac-tor analysis showed that fasting blood glucose, T stage, uric acid and PP-NLR levels were related to the prognosis of NSCLC patients (all P < 0.05). Multifactor COX analysis showed that PP-NLR and uric acid were independent risk factors affecting the prognosis of patients. Conclusion: PP-NLR score is an independent prognostic indicator of NSCLC patients who have undergone surgery, which is help-ful for clinicians to stratify the risk of patients, screen high-risk patients, and provide more effective clinical decision-making guidance.