Effect of pre-radiotherapy NLR, PLR and LMR on the prognosis of patients with brain metastases and analysis of related factors
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摘要:
目的 探讨放疗前外周血中性粒细胞-淋巴细胞比值（NLR）、血小板-淋巴细胞比值（PLR）及淋巴细胞-单核细胞比值（LMR）对脑转移患者全脑放疗预后的影响。 方法 回顾性纳入118例脑转移患者的临床资料，分析各个炎性复合指标和临床资料与脑转移瘤患者全脑放疗预后的关系。采用ROC曲线确定脑转移瘤患者全脑放疗预后NLR、PLR及LMR的临界值。采用Kaplan-Meier法进行单因素生存分析、Log-rank检验进行各组生存率之间的比较，采用Cox比例风险模型进行多因素回归分析。 结果 118例脑转移瘤患者的中位生存期为12.5月，1年、2年生存率分别为72.8%和50.1%。通过ROC曲线确定NLR、PLR和LMR的临界值分别为4.28、217.8和1.95。Kaplan-Meier单因素分析显示，肿瘤分期、靶向治疗、NLR、PLR以及LMR均是影响脑转移瘤患者全脑放疗预后的危险因素（P=0.001、0.032、0.008、0.003、0.002），进一步多因素Cox回归分析表明PLR是唯一的独立不良预后因素（P=0.003）。 结论 放疗前外周血PLR升高是脑转移瘤患者全脑放疗的独立不良预后因素。 -
关键词:
- 脑转移 /
- 全脑放疗 /
- 中性粒细胞-淋巴细胞比值 /
- 血小板-淋巴细胞比值 /
- 淋巴细胞-单核细胞比值
Abstract:Objective To investigate the relationship between peripheral blood neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and lymphocyte to monocyte ratio (LMR) and prognosis of patients with brain metastases. Methods A total of 118 patients with brain metastases treated with whole brain radiotherapy were retrospectively analyzed. The relationship of NLR, PLR, LMR and clinical data with the prognosis patients were analyzed. Receiver operating characteristic curve was used to calculate the optimal cut-off values of NLR, PLR and LMR. The overall survival analysis was performed by Kaplan- Meier method. Significant differences were analyzed by Log-rank test. Multivariate analysis for survival was performed by Cox proportional regression model. Results The median overall survival time of 188 patients with brain metastases was 12.5 months. The 1-year, 2-year survival rates were 72.8% and 50.1%, respectively. The optimal cut-off values of NLR, PLR and LMR were determined by ROC curve to be 4.28, 217.8 and 1.95, respectively. The tumor stage, targeted therapy, NLR, PLR, and LMR were all associated with the prognosis of patients with brain metastases (P=0.001, 0.032, 0.008, 0.003, 0.002). The PLR were an independent prognostic factors for the patients with brain metastases (P=0.003). Conclusion The peripheral blood PLR before whole brain radiotherapy may be an independent prognostic factor in the patients with brain metastases. -
图 1 脑转移瘤患者全脑调强放疗计划布野示意图
Figure 1. Schematic diagram of intensity-modulated radiotherapy plan for patient metastasis.
图 2 脑转移瘤患者全脑放疗预后NLR、PLR及LMR的受试者工作特征曲线
Figure 2. Receiver operating characteristic curve of the patients with brain metastasis treated with whole brain radiotherapy according to the NLR, PLR and LMR.
图 4 118例脑转移患者不同NLR(A)、PLR(B)、LMR(C)的生存曲线
Figure 4. Overall survival curves of 118 patients with brain metastasis treated with whole brain radiotherapy according to NLR (A), PLR(B), and LMR(C).
表 1 118例脑转移患者总生存期的单因素分析结果
Table 1. Univariate analyses of OS in 118 patients with brain metastases
临床特征 例数（n） χ2 P 临床特征 例数（n） χ2 P 性别 0.962 0.330 化疗 0.204 0.650 男 47 是 83 女 71 否 35 年龄(岁) 2.310 0.130 手术 2.97 0.085 ≤ 70 86 是 104 > 70 32 否 14 卡氏功能 0.625 0.430 靶向治疗 4.570 0.032 ≤ 70 67 是 79 > 70 51 否 39 脑转移数目 0.164 0.690 NLR 6.950 0.008 ≤ 3 31 ≤ 4.28 62 > 3 87 > 4.28 56 颅外转移 0.098 0.750 PLR 8.610 0.003 是 57 ≤ 217.8 35 否 61 > 217.8 83 肿瘤分期 10.300 0.001 LMR 9.980 0.002 T1~T2 61 ≤ 1.95 29 T3~T4 23 > 1.95 89 NLR: 中性粒细胞-淋巴细胞比值; PLR: 血小板-淋巴细胞比值; LMR: 淋巴细胞-单核细胞比值. 
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表 2 118例脑转移患者总生存期的多因素Cox回归分析
Table 2. Multivariate Cox risk regression model analysis of OS in 118 patients with brain metastases
临床因素 B S.E. Wald HR (95% CI) P 肿瘤分期(T3~T4 vs T1~T2) 1.046 0.564 -1.87 2.845 (0.942~8.588) 0.064 手术(是vs否) -0.657 0.709 -0.93 2.298(0.962~5.490) 0.354 靶向治疗(否vs是) -0.832 0.444 1.85 0.519 (0.129~2.082) 0.061 NLR (>4.28vs≤4.28) -0.524 0.735 -0.71 0.592 (0.140~2.500) 0.476 PLR (≤217.8vs>217.8) 2.012 0.670 3.00 0.134 (0.035~0.497) 0.003 LMR (≤1.95vs>1.95) -1.121 0.731 -1.53 3.067 (0.732~12.848) 0.125
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