作者：施萍，杜永亮

单位：

221000 江苏省徐州市，徐州医科大学第二附属医院呼吸内科；通信作者：杜永亮，E-mail：13813297523@163.com

Units：

Department of Respiratory Medicine，the Second Affiliated Hospital of Xuzhou Medical University，Xuzhou 221000，China；Corresponding author：DU Yongliang，E-mail：13813297523@163.com

关键词：

癌，非小细胞肺；中性粒细胞与淋巴细胞比值；初诊；预后

Keywords：

Carcinoma，non-small-cell lung；Neutrophil-to-lymphocyte ratio；Initial diagnosis；Prognosis

CLC：

R 730.26

DOI：

DOI：10.3969/j.issn.1008-5971.2020.03.015

Funds：

基金项目：徐州市科技项目（KC17163）

摘要：

背景　多数非小细胞肺癌（NSCLC）患者预后并不十分理想，而目前关于外周血中性粒细胞与淋巴细胞比值（NLR）与初诊晚期 NSCLS 患者预后关系的研究报道较少见。目的　探讨外周血 NLR 与初诊晚期 NSCLC 患者预后的关系。方法　选取 2014—2015 年徐州医科大学第二附属医院收治的初诊晚期 NSCLC 患者 83 例，根据存活情况分为存活组 8 例与死亡组 75 例。通过 ROC 曲线确定外周血 NLR 预测初诊晚期 NSCLC 患者预后的最佳临界值，比较存活组与死亡组患者临床特征及 NLR，采用多元 Cox 比例风险回归分析初诊晚期 NSCLC 患者预后的影响因素。根据外周血 NLR 预测初诊晚期 NSCLC 患者预后的最佳临界值将所有患者分为低 NLR 组 34 例与高 NLR 组 49 例，比较低 NLR 组与高 NLR 组患者临床特征；绘制 Kaplan-Meier 生存曲线以比较低 NLR 组与高 NLR 组患者生存情况。结果　（1）ROC曲线显示，外周血NLR预测初诊晚期NSCLC患者预后的曲线下面积（AUC）为0.788 〔95%CI （0.716，0.832）〕，最佳临界值为 2.73。（2）存活组与死亡组患者 TNM 分期、组织分化程度、器官转移发生率、NLR 比较，差异有统计学意义（P<0.05）；两组患者男性比例、年龄、吸烟率、肿瘤类型及病理类型比较，差异无统计学意义（P>0.05）。（3）多元 Cox 比例风险回归分析结果显示，TNM 分期、组织分化程度、外周血 NLR 是初诊晚期 NSCLC 患者预后的独立影响因素（P<0.05）。（4）低 NLR 组与高 NLR 组患者 TNM 分期、组织分化程度、器官转移发生率比较，差异有统计学意义（P<0.05）；两组患者男性比例、年龄、吸烟率、肿瘤类型、病理类型比较，差异无统计学意义（P>0.05）（5）Kaplan-Meier 生存曲线显示，高 NLR 组患者 3 年累积生存率低于低 NLR 组（P<0.05）。结论　外周血 NLR 是初诊晚期 NSCLC 患者预后的独立影响因素，外周血 NLR 升高（≥ 2.73）的初诊晚期 NSCLC 患者的生存期较短。

Abstract：

Background　The prognosis is not yet ideal in most of patients with non-small cell lung cancer （NSCLC），however there are few reports about relationship between peripheral blood neutrophils to lymphocytes ratio（NLR）and prognosisin patients with newly diagnosed advanced NSCLC so far. Objective　To investigate the relationship between peripheral bloodNLR and prognosis in patients with newly diagnosed advanced NSCLC. Methods　A total of 83 patients with newly diagnosedadvanced NSCLC were selected in the Second Affiliated Hospital of Xuzhou Medical University from 2014 to 2015，and theywere divided into survival group（n=8）and death group（n=75） according to survival status. ROC curve was used to determinethe optimum critical value of peripheral blood NLR in predicting prognosis in patients with newly diagnosed advanced NSCLC，clinical features and NLR were compared between survival group and death group，and influencing factors of prognosis inpatients with newly diagnosed advanced NSCLC were analyzed by multivariate Cox proportional hazards regression analysis. All ofthe patients were divided into low-NLR group（n=34）and high-NLR group（n=49）according to the optimum critical value ofperipheral blood NLR in predicting prognosis in patients with newly diagnosed advanced NSCLC，clinical features were comparedbetween low-NLR group and high-NLR group，and Kaplan-Meier survivorship curve was used to analyze the survival statusbetween low-NLR group and high-NLR group. Results　（1）ROC curve analysis results showed that，AUC and optimumcritical value of peripheral blood NLR in predicting prognosis in patients with newly diagnosed advanced NSCLC was 0.788〔95%CI（0.716，0.832）〕 and 2.73，respectively.（2）There were statistically significant differences in TNM stage，degree of tissue differentiation，incidence of organ metastasis and NLR between survival group and death group（P<0.05），while no statistically significant difference of male ratio，age，smoking rate，tumor types or pathological types was foundbetween the two groups（P>0.05）.（3）Multivariate Cox proportional hazards regression analysis results showed that，TNMstage，degree of tissue differentiation and peripheral blood NLR were independent influencing factors of prognosis in patientswith newly diagnosed advanced NSCLC（P<0.05）.（4）There were statistically significant differences in TNM stage，degreeof tissue differentiation and incidence of organ metastasis between low-NLR group and high-NLR group（P<0.05），whileno statistically significant difference in male ratio，age，smoking rate，tumor types or pathological types was found betweenthe two groups（P>0.05）.（5）Kaplan-Meier survivorship curve showed that，3-year cumulative survival rate in high-NLRgroup was statistically significantly lower than that in low-NLR group（P<0.05）. Conclusion　Peripheral blood NLR is oneof independent influencing factors of prognosis in patients with newly diagnosed advanced NSCLC，survival time is relatively innewly diagnosed advanced NSCLC patients with high peripheral blood（≥ 2.73）.

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