作者：王燕，包阳，唐月红，施庆彤，董祥翔

单位：

225009江苏省扬州市，扬州大学附属医院胸外科 通信作者：唐月红，E-mail：13912146158@163.com

Units：

Department of Thoracic Surgery, Affiliated Hospital of Yangzhou University, Yangzhou 225009, China Corresponding author: TANG Yuehong, E-mail: 13912146158@163.com

关键词：

肺肿瘤; 淋巴细胞与单核细胞比值; 预测价值; 影响因素分析;

Keywords：

Lung neoplasms; Lymphocyte to monocyte ratio; Predictive value; Root cause analysis

CLC：

DOI：

10.12114/j.issn.1008-5971.2022.00.063

Funds：

摘要：

背景淋巴细胞与单核细胞比值(LMR)已被证实是临床预测宫颈癌、鼻咽癌等多种恶性肿瘤患者预后的有效指标,但其对肺癌患者预后的预测价值尚需进一步证实。目的 探讨LMR与肺癌患者预后的关系,以期为临床早期预测肺癌患者预后提供更多依据。方法 回顾性选取2014年10月至2016年10月扬州大学附属医院收治的278例肺癌患者,根据患者随访5年的生存情况分为存活组和死亡组。比较两组患者性别、年龄、吸烟史、饮酒史、卡氏评分(KPS)、淋巴结转移情况、肿瘤直径、TNM分期、病理类型、病变范围、体质指数、骨髓抑制情况、LMR。采用多元Cox比例风险回归分析探讨肺癌患者预后的影响因素,绘制受试者工作特征(ROC)曲线以评估LMR对肺癌患者预后的预测价值。结果 本组患者3年存活率为50.36%(140/278),5年存活率为30.22%(84/278)。死亡组中年龄≥60岁、KPS<80分、淋巴结转移、TNM分期为Ⅲ～Ⅳ期者占比高于存活组,肿瘤直径大于存活组,LMR低于存活组(P<0.05)。多元Cox比例风险回归分析结果显示,KPS<80分〔HR=2.615,95%CI(1.424,4.803)〕、淋巴结转移〔HR=2.053,95%CI(1.078,3.909)〕、肿瘤直径增大〔HR=1.885,95%CI(1.478,2.403)〕、TNM分期为Ⅲ～Ⅳ期〔HR=2.074,95%CI(1.090,3.946)〕及LMR降低〔HR=0.700,95%CI(0.521,0.942)〕是肺癌患者预后的独立危险因素(P<0.05)。ROC曲线分析结果显示,LMR预测肺癌患者预后的曲线下面积为0.839〔95%CI(0.805,0.892)〕,最佳截断值为4.11,灵敏度、特异度分别为85.57%、65.48%。结论 KPS<80分、淋巴结转移、肿瘤直径增大、TNM分期为Ⅲ～Ⅳ期及LMR降低是肺癌患者预后的独立危险因素,其中LMR对肺癌患者预后具有一定预测价值。

Abstract：

【Abstract】　Background Lymphocyte to monocyte ratio (LMR) has been proved to be an effective index in predictingthe prognosis of patients with various malignant tumors such as cervical cancer and nasopharyngeal carcinoma, but its predictivevalue in the prognosis of patients with lung cancer needs further confirmation. Objective To discuss the relationship betweenLMR and the prognosis of patients with lung cancer, in order to provide more basis for clinical early prediction of the prognosisof lung cancer patients. Methods A total of 278 patients with lung cancer in Affiliated Hospital of Yangzhou University fromOctober 2014 to October 2016 were selected as the study objects, and they were divided into the survival group and the deathgroup according to survival after 5 years' followed-up. Gender, age, smoking history, drinking history, Karnofsky (KPS) , lymphnode metastasis, tumor diameter, TNM stage, pathological type, lesion range, body mass index, bone marrow inhibition, LMRwere compared between the two groups. Multivariate Cox proportional risk regression analysis was used to discuss the prognosticfactors of patients with lung cancer, and receiver operating characteristic (ROC) curve was drawn to evaluate the predictive valueof LMR in predicting the prognosis of lung cancer patients.Results In this group, 3-year survival rate of patients was 50.36%(140/278) , 5-year survival rate was 30.22% (84/278) . Proportion of age≥ 60 years old, KPS < 80 score, lymph node metastasis,TNM stage of Ⅲ-Ⅳ in the death group was higher than that of the survival group, tumor diameter was bigger than that of thesurvival group, LMR was lower than that of the survival group (P < 0.05) . Multivariate Cox proportional risk regression analysisresults showed that, KPS < 80 score [HR=2.615, 95%CI (1.424, 4.803) ] , lymph node metastasis [HR=2.053, 95%CI (1.078,3.909) ] , enlargement of tumor diameter [HR=1.885, 95%CI (1.478, 2.403) ] , TNM stage of Ⅲ-Ⅳ [HR=2.074, 95%CI (1.090,3.946) ] and decrease of LMR [HR=0.700, 95%CI (0.521, 0.942) ] were independent risk factors for prognosis in patients withlung cancer (P < 0.05) . ROC curve analysis results showed that, area under curve of LMR in predicting the prognosis of patientswith lung cancer was 0.839 [95%CI (0.805, 0.892) ] , the optimal cutoff value was 4.11, sensitivity and specificity was 85.57%,65.48%, respectively.ConclusionKPS < 80 score, lymph node metastasis, enlargement of tumor diameter, TNM stage of Ⅲ-Ⅳand decrease of LMR are independent risk factors for prognosis in patients with lung cancer, and LMR has a certain prognosticpredictive value of patients with lung cancer.

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