术前外周血NLR,dNLR及LMR在胶质母细胞瘤患者预后评估中的价值分析

目的 评价术前外周血中性粒细胞/淋巴细胞比值(NLR)、间接中性粒细胞/淋巴细胞比值(dNLR)、淋巴细胞/单核细胞比值(LMR)与胶质母细胞瘤(GBM)患者预后的关系,探讨这些指标的预后评估价值. 方法回顾性分析98例GBM患者的临床资料和随访资料,分析NLR,dNLR和LMR之间的相关性,通过受试者工作特征曲线(ROC曲线)确定NLR,dNLR和LMR预测术后生存的最佳分界点,并以此将患者分为高值组和低值组,分析其与患者临床病理特征之间的相关性.采用Kaplan-M eier生存分析、单因素及多因素Cox回归分析,评估术前外周血 NLR,dNLR和 LMR对 GBM 患者术后生存的影响. 结果 术前 NLR 与 dNLR呈明显正相关(P<0.001),NLR与LMR以及 dNLR与 LMR则呈负相关(P< 0.001).ROC 曲线分析确定 NLR,dNLR和LMR预测生存的最佳分界点分别为2.42,1.53和3.85.NLR≤2.42组和 NLR> 2.42组、dNLR≤1.53组和dNLR>1.53组、LMR<3.85组和LMR≥3.85组患者生存时间比较,差别有统计学意义(P<0.001),而性别、年龄、肿瘤位置和肿瘤大小比较,差别无统计学意义.Kaplan-Meier生存分析结果显示,NLR≤2.42组的患者生存时间(中位生存期15月)明显长于NLR>2.42组(中位生存期11月)(P<0.05);dNLR≤1.53的GBM患者,其生存时间(中位生存期17月)要长于dNLR>1.53的患者(中位生存期12月)(P<0.05);LMR<3.85的患者生存时间(中位生存期10月)则要明显短于LM R≥3.85组(中位生存期14.5月)(P<0.05).单因素和多因素Cox回归分析结果显示,NLR,dNLR和LMR均为影响GBM患者预后的因素(P<0.001),但只有NLR和LMR为预测GBM患者生存的独立预后因素(P<0.05),且NLR的预测效果要优于LMR. 结论 术前NLR,dNLR和LMR均为影响GBM患者预后的因素,其中NLR和LMR为独立预后因素,且NLR对GBM 患者术后生存的预测效果优于LMR.

The Prognostic Role of Preoperative Neutrophil-lymphocyte Ratio, Derived Neutrophil-lymphocyte Ratio and Lymphocyte-monocyte Ratio for Patients with Glioblastoma

Objective To explore the prognostic role of preoperative neutrophil-lymphocyte ratio (NLR),derived neutrophil-lymphocyte ratio(dNLR)and lymphocyte-monocyte ratio(LMR)for patients with glioblastoma(GBM). Methods A total of 98 patients with GBM from the First Affiliated Hospital of Fujian Medical University and Fujian Provincial Hospital were retrospectively analyzed. The correla-tions between NLR,dNLR and LMR were explored. The receiver operating characteristic(ROC)curve analysis was performed to obtain the optimal cut-off values of NLR,dNLR and LMR for predicting post-operative survival. Patients were divided into two groups according to the cut-off value of NLR,dNLR and LMR respectively. The associations between clinical characteristics and pre-operative NLR,dNLR and LMR in 98 patients with GBM were further analyzed. The prognostic value of NLR,dNLR and LMR was evaluated by Kaplan-Meier survival analysis,univariate and multivariate Cox regression analy-sis. Results Spearman's correlation coefficient test revealed a positive correlation between NLR and dNLR(P<0.001)while a negative correlation between NLR and LMR(P<0.001),dNLR and LMR as well(P<0.001). ROC analysis supported 2.42,1.53 and 3.85 as the optimal cut-off values of NLR, dNLR and LMR respectively. Significant associations between NLR,dNLR,LMR and survival time were observed(P<0.001)whereas there were no significant differences between NLR,dNLR,LMR and other clinical features,including age,gender,tumor location and tumor size. Kaplan-Meier survival analysis indicated that patients with NLR≤2.42[median overall survival time(OS)=15 months]had a longer survival time than those with NLR>2.42(median OS=11 months)(P<0.05). The overall sur-vival(OS)of patients with dNLR>1.53(median OS=12 months)was shorter than that of patients with dNLR≤1.53(median OS = 17 months)(P< 0.05). Besides,patients with LMR ≥ 3.85(median OS=14.5 months)had a significantly better outcome than those with LMR <3.85(median OS=10 months)(P<0.05). Univariate and multivariate Cox regression analyses showed that preopera-tive NLR,dNLR and LMR were significant predictors of OS(P< 0.001). However,only NLR and LMR were independent predictors of OS in GBM patients(P<0.05)and NLR was superior to LMR as a prognostic factor. Conclusion Preoperative NLR,dNLR and LMR are potential prognostic biomarkers in patients with GBM. NLR and LMR are independent predictors of OS in patients with GBM and NLR is superior to LM R as a prognostic factor.