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手术前后NLR对口腔癌患者预后预测价值的研究
作者:苏晓平  陈伯莉  邓丽  张敬雷 
单位:联勤保障部队第九○九医院(厦门大学附属东南医院) 口腔科, 福建 漳州 363000
关键词:口腔鳞状细胞癌 中性粒细胞 淋巴细胞 总体生存期 无病生存期 
分类号:R739.8
出版年·卷·期(页码):2022·50·第五期(561-567)
摘要:

目的:研究手术前后中性粒细胞/淋巴细胞(NLR)对口腔鳞状细胞癌患者(OSCC)预后预测价值。方法:选取2012年10月至2020年1月于我院行口腔癌根治术的原发性OSCC患者123例,收集所有患者术前最后一次和术后3个月血常规,通过Cox回归分析和Kaplan-Meier (K-M)生存曲线分析手术前后NLR对OSCC患者总体生存期(OS)、无病生存期(DFS)的影响。结果:术前NLR预测患者生存和死亡的曲线下面积(AUC)为0.670(0.570~0.770),最佳截断值为2.74;术后NLR预测患者生存和死亡的AUC为0.643(0.544~0.743),最佳截断值为3.13。术前NLR≥2.74组患者死亡率高于术前NLR<2.74组,T1-T2占比、病理Ⅰ期占比低于术前NLR<2.74组。术后NLR≥3.13组患者术后伤口感染率、放化疗率均高于NLR<3.13组,术后Hb低于NLR<3.13组,差异有统计学意义(均P<0.05)。术前NLR低值组OS、DFS中位数高于术前NLR高值组,经Log-rank统计分析两组间差异均有统计学意义(P<0.05);术后NLR低值组OS中位数高于术后NLR高值组,差异均有统计学意义(P<0.05);术后NLR低值组DFS中位数高于术后NLR高值组,但差异无统计学意义(P>0.05)。Cox回归分析显示,肿瘤大小(T3-T4/T1-T2)、临床分期(Ⅲ-Ⅳ/Ⅰ-Ⅱ)、病理分期(Ⅱ-Ⅲ/Ⅰ)、术前NLR≥2.74、术后NLR≥3.13均为OS预后的独立影响因素,其HR值分别为2.706、2.949、2.219、2.015、1.985。临床分期(Ⅲ-Ⅳ/Ⅰ-Ⅱ)、病理分期(Ⅱ-Ⅲ/Ⅰ)、颈淋巴结转移、放疗或化疗、术前NLR≥2.74均为DFS的独立影响因素,其HR值分别为1.687、2.451、1.912、0.696、1.830。结论:手术前后NLR对不良预后有一定预测价值,术前NLR≥2.74为OSCC患者根治术后OS及DFS的独立影响因素,术后NLR≥3.13为根治术后OS独立影响因素。

Objective:To study the prognostic value of preoperative neutrophil to lymphocyte ratio(NLR) and postoperative NLR in patients with oral squamous cell carcinoma(OSCC). Methods:One hundred and twenty-three patients with primary OSCC undergoing radical operation of oral cancer in our hospital from October 2012 to January 2020 were selected. The data of blood routine of all the patients last time before operation and 3 months after operation were collected. The effects of preoperative and postoperative NLR on overall survival(OS) and disease-free survival(DFS) of OSCC patients were analyzed by Cox regression analysis and Kaplan-Meier(K-M) survival curve. Results:The area under the curve(AUC) of preoperative NLR was 0.670(0.570-0.770), and the best cutoff value was 2.74. The AUC of postoperative NLR was 0.643(0.544-0.743), and the best cutoff value was 3.13. The rate of postoperative wound infection and chemoradiotherapy in patients with NLR ≥ 3.13 group was higher than that in patients with NLR<3.13 group, and postoperative Hb was lower than that in patients with NLR<3.13 group, the differences being statistically significant(all P<0.05). The median of OS and DFS in the low preoperative NLR group was higher than that in the high preoperative NLR group, and the differences between the two groups were statistically significant(P<0.05). The median of OS of low NLR group was higher than that of high NLR group(P<0.05). The median of DFS of low NLR group was higher than that of high NLR group(P>0.05). Cox regression analysis showed that tumor size(T3-T4/T1-T2), clinical stage(Ⅲ-Ⅳ/Ⅰ-Ⅱ), pathological stage(Ⅱ-Ⅲ/Ⅰ), preoperative NLR ≥ 2.74 and postoperative NLR ≥ 3.13 were independent prognostic factors of OS, and their HR values were 2.706, 2.949, 2.219, 2.015 and 1.985, respectively. Clinical stage(Ⅲ-Ⅳ/Ⅰ-Ⅱ), pathological stage(Ⅱ-Ⅲ/Ⅰ), cervical lymph node metastasis, radiotherapy or chemotherapy, preoperative NLR ≥ 2.74 were independent influencing factors of DFS, and their HR values were 1.687, 2.451, 1.912, 0.696 and 1.830, respectively. Conclusion:Preoperative and postoperative NLRs have certain predictive value for poor prognosis. Preoperative NLR ≥ 2.74 is an independent influencing factor for OS and DFS in patients with OSCC after radical resection, and postoperative NLR ≥ 3.13 is an independent influencing factor for OS after radical operation.

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