NLR联合AGR评估食管鳞状细胞癌患者预后的临床价值

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摘要目的探讨中性粒细胞-淋巴细胞计数比率 (NLR)、白蛋白-球蛋白比率(AGR)与食管鳞状细胞癌(ESCC)患者总生存(OS)期的关系,评估两项指标联合对预测 ESCC 患者预后的应用价值。方法本研究回顾性分析了自 2015 年 01 月至 2019 年 12 月间于南通大学附属如皋医院首诊并接受手术治疗的 144 例 ESCC 患者的血常规、血生化检测结果与随访数据。通过受试者操作特征(ROC)曲线确定 NLR、AGR 的最佳临界值,利用曲线下面积(AUC)评估各指标对 ESCC 患者 OS 期的预测效能。通过 Kaplan-Meier 曲线及 Cox 单、多变量回归分析评估两种预测指标的预后价值。结果根据期曲线,NLR 与 AGR 预测 ESCC 患者 OS 期的最佳截断值分别为 1. 45 和 1. 48, AUC 值分别为 0. 713 (95%CI = 0. 628 ~ 0. 797)和 0. 673 (95%CI = 0. 584~ 0. 761)。 Kaplan-Meier 曲线展示高 NLR( >1. 45)与低 NLR(≤1. 45)组患者的中位 OS 期分别为 51. 8 个月(95%CI = 36. 2~ 67. 3)和 20. 1 个月(95%CI = 14. 1~ 26. 2),差异有统计学意义(χ 2 = 20. 474, P<0. 001)。术前低 AGR 值( <1. 48)与 ESCC 患者不良预后显著相关[中位 OS 期:22. 5 个月 (95%CI = 15. 1 ~ 29. 9)比 43. 3 个月 (95%CI = 25. 7 ~ 60. 8)],差异有统计学意义 (χ 2 = 6. 749, P= 0. 009)。单、多变量 Cox 分析证实淋巴结转移(HR = 3. 626, 95%CI = 2. 152 ~ 6. 110,P<0. 001)、NLR (HR= 1. 960, 95%CI = 1. 198~ 3. 207,P= 0. 007)与 AGR (HR= 1. 791, 95%CI = 1. 099 ~ 2. 920,P = 0. 019)是 ESCC 患者的独立预后因素。此外,我们发现 NLR 联合 AGR 评分(0 分:NLR≤1. 45 且 AGR≥1. 48;1 分: NLR>1. 45 或 AGR<1. 48;2 分:NLR> 1. 45 且 AGR<1. 48 )能够进一步分层 ESCC 患者的预后,患者评分越高,预后越差。 0 分、1 分与 2 分患者的中位 OS 期分别为 56. 6 个月(95%CI = 40. 2~ 67. 3)、29. 9 个月(95%CI = 20. 1~ 39. 8)和 18. 2 个月(95%CI = 12. 1~ 24. 3),组间差异有统计学意义 (0 分比 1 分: χ 2 = 6. 795, P= 0. 009;0 分比 2 分: χ 2 = 19. 529, P<0. 001;1 分比 2 分: χ 2 = 7. 011, P = 0. 008)。结论 NLR 与 AGR 是评估 ESCC 患者预后的敏感指标,两者联合可以更有效地识别预后不良患者,进而提供更为详尽的预后分层。

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	吴丹
	周丽丽
	石海燕

关键词 ：食管鳞状细胞癌, 中性粒细胞-淋巴细胞计数比率, 白蛋白-球蛋白比率, 预后价值

Abstract： Objective To investigate the correlations between neutrophil - to - lymphocyte ratio NLR as well as albumin - to - globulin ratio AGR and overall survival OS of esophageal squamous cell carcinoma ESCC patients and evaluate the prognostic value of their combination. Method A total of 144 ESCC patients who were initially diagnosed and treated with surgical resection in our institution from January 2015 to December 2019 were included in this study and their data of laboratory test and postoperative followup were retrospectively collected and analyzed. The best thresholds of NLR and AGR were determined by receiver operation characteristics ROC curve and the area under curve AUC value was used to evaluate their predictive performance. The prognostic values of NLR and AGR for ESCC patients were evaluated using Kaplan-Meier method and the multivariate Cox regression analysis. Result According to the ROC curves the optimal cut-off values of NLR and AGR for survival prediction of ESCC patients were 1. 45 and 1. 48 respectively. The AUC values of NLR and AGR were 0. 713 95% CI = 0. 628 - 0. 797 and 0. 673 95% CI = 0. 584 - 0. 761 respectively. Kaplan-Meier curves indicated that the median OS of patients with high NLR >1. 45 and low NLR ≤1. 45 was 51. 8 months 95%CI = 36. 2-67. 3 and 20. 1 months 95%CI = 14. 1-26. 2 with a significantly statistical difference χ 2 = 20. 474 P<0. 001 . In contrast preoperative low AGR <1. 48 was significantly associated with poor OS of ESCC patients median ·456· 肿瘤代谢与营养电子杂志 2022 年 8 月 9 日第 9 卷第 4 期 Electron J Metab Nutr Cancer, Aug. 9, 2022, Vol. 9, No. 4 OS 22. 5 months 95%CI = 15. 1 - 29. 9 vs 43. 3 months 95% CI = 25. 7 - 60. 8 χ 2 = 6. 749 P = 0. 009 . The univariate and multivariate Cox analysis identified lymph node metastasis HR = 3. 626 95% CI = 2. 152- 6. 110 P< 0. 001 NLR HR = 1. 960 95%CI = 1. 198-3. 207 P= 0. 007 and AGR HR= 1. 791 95%CI = 1. 099-2. 920 P= 0. 019 as independent prognostic factors for ESCC patients. Additionally we found that the prognosis of ESCC patients could be further stratified by the combination of NLR and AGR 0 point NLR≤1. 45 and AGR≥1. 48 1 point NLR>1. 45 or AGR<1. 48 2 point NLR > 1. 45 and AGR<1. 48 . The higher score the poorer OS in ESCC patients. The median OS of patients with 0 1 and 2 points were 56. 6 months 95%CI = 40. 2- 67. 3 29. 9 months 95%CI = 20. 1-39. 8 and 18. 2 months 95%CI = 12. 1-24. 3 respectively. There were significant survival differences between different patient groups 0 vs 1 point χ 2 = 6. 795 P= 0. 009 0 vs 2 points χ 2 = 19. 529 P<0. 001 1 vs 2 points χ 2 = 7. 011 P = 0. 008 . Conclusion NLR and AGR were identified as sensitive predictors of prognostic assessment and their combination could provide a proper prognostic stratification for ESCC patients.

Key words： Esophageal squamous cell carcinoma Neutrophil-to-lymphocyte ratio Albumin-to-globulin ratio Prognostic value

收稿日期: 2022-02-02

基金资助:南通市科技局 2021 年民生科技计划项目 MS21035

通讯作者: 石海燕电子邮箱 2621916791@qq.com

引用本文:

吴丹,周丽丽,石海燕. NLR联合AGR评估食管鳞状细胞癌患者预后的临床价值[J]. 肿瘤代谢与营养电子杂志, 2022, 9(4): 456-462.
Wu Dan,Zhou Lili, Shi Haiyan. Clinical value of NLR combined with AGR in evaluating the prognosis of patients with esophageal squamous cell carcinoma. Electron J Metab Nutr Cancer, 2022, 9(4): 456-462.