NLR、PLR对术前舌鳞状细胞癌颈淋巴结转移的诊断价值分析

doi:10.12439/kqhm.1005-4979.2024.06.006

摘要/Abstract

摘要：

目的：分析术前血液炎症指标诊断舌鳞状细胞癌（tongue squamous cell carcinoma，TSCC）患者颈淋巴结转移的临床价值。方法：纳入2017年1月至2023年6月于河南省人民医院行手术治疗的141例TSCC患者，根据术后病理结果分为颈淋巴结转移组和颈淋巴结未转移组，收集患者手术前外周血炎症细胞（中性粒细胞、血小板和淋巴细胞）指标，并计算中性粒细胞与淋巴细胞比值（neutrophil to lymphocyte ratio，NLR）和血小板与淋巴细胞比值（platelet to lymphocyte ratio，PLR），分析术前NLR及PLR诊断TSCC患者颈淋巴结转移的价值。结果：颈淋巴结转移组的NLR及PLR值明显高于颈淋巴结未转移组。NLR及PLR诊断TSCC患者颈淋巴结转移的曲线下面积和最佳截断值分别为0.72、2.24和0.61、115.43。多因素Logistic回归分析结果显示，NLR是TSCC患者颈淋巴结转移的独立影响因素。结论：术前炎症指标NLR可能是评估TSCC患者颈淋巴结转移的潜在标志物。

关键词: 舌鳞状细胞癌, 中性粒细胞与淋巴细胞比值, 血小板与淋巴细胞比值, 颈淋巴结转移

Abstract:

Objective: To analyze the clinical value of preoperative blood inflammatory markers in diagnosing cervical lymph node metastasis in patients with tongue squamous cell carcinoma (TSCC). Methods: A total of 141 TSCC patients who underwent surgical treatment in Henan Provincial People's Hospital from January 2017 to June 2023 were included. According to the postoperative pathological results, they were divided into cervical lymph node metastatic group and cervical lymph node non-metastatic group. The index of peripheral blood inflammatory cells (neutrophil, platelet, and lymphocyte count values) were collected from patients before surgery, and the neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) were calculated to analyze the value of preoperative NLR and PLR in diagnosing cervical lymph node metastasis in TSCC patients. Results: The NLR and PLR values in cervical lymph node metastatic group were significantly higher than those in the cervical lymph node non-metastatic group. The area under the curve (AUC) and optimal cutoff values for diagnosing cervical lymph node metastasis in TSCC patients using NLR and PLR are 0.72, 2.24 and 0.61, 115.43, respectively. Multivariate logistic regression analysis showed that NLR is an independent influencing factor for cervical lymph node metastasis in TSCC patients. Conclusion: The preoperative inflammatory marker NLR may be a potential biomarker for evaluating cervical lymph node metastasis in TSCC patients.

Key words: tongue squamous cell carcinoma, neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, cervical lymph node metastasis

中图分类号:

R782
R739.8

程龙龙, 张诗涵, 孟鑫, 张静睿, 周莹, 王永功. NLR、PLR对术前舌鳞状细胞癌颈淋巴结转移的诊断价值分析[J]. 《口腔颌面外科杂志》, 2024, 34(6): 453-458.

CHENG Longlong, ZHANG Shihan, MENG Xin, ZHANG Jingrui, ZHOU Ying, WANG Yonggong. Analysis of the diagnostic value of NLR and PLR in cervical lymph node metastasis of tongue squamous cell carcinoma before surgery[J]. 《Journal of Oral and Maxillofacial Surgery》, 2024, 34(6): 453-458.

https://journal06.magtech.org.cn/Jweb_joms/CN/Y2024/V34/I6/453

图/表 5

参考文献 25

[1]	Siegel R, Giaquinto AN, Jemal A. Cancer statistics, 2024[J]. CA A Cancer J Clin, 2024, 74: 12-49.
[2]	陈震, 章文博, 彭歆. 口腔鳞状细胞癌cN+颈部处理的研究进展[J]. 口腔疾病防治, 2021, 29(11): 776-781. doi: 10.12016/j.issn.2096-1456.2021.11.009
[3]	Park KS, Choi Y, Kim J, et al. Prognostic value of MRI-measured tumor thickness in patients with tongue squamous cell carcinoma[J]. Sci Rep, 2021, 11(1): 11333.
[4]	Haider SP, Burtness B, Yarbrough WG, et al. Applications of radiomics in precision diagnosis, prognostication and treatment planning of head and neck squamous cell carcinomas[J]. Cancers Head Neck, 2020, 5: 6. doi: 10.1186/s41199-020-00053-7 pmid: 32391171
[5]	Kennel KB, Bozlar M, De Valk AF, et al. Cancer-associated fibroblasts in inflammation and antitumor immunity[J]. Clin Cancer Res, 2023, 29(6): 1009-1016.
[6]	Wang MN, Zhao JZ, Zhang LS, et al. Role of tumor microenvironment in tumorigenesis[J]. J Cancer, 2017, 8(5): 761-773. doi: 10.7150/jca.17648 pmid: 28382138
[7]	Swierczak A, Mouchemore KA, Hamilton JA, et al. Neutrophils: Important contributors to tumor progression and metastasis[J]. Cancer Metastasis Rev, 2015, 34(4): 735-751.
[8]	Choi JH, Suh YS, Choi Y, et al. Comprehensive analysis of the neutrophil-to-lymphocyte ratio for preoperative prognostic prediction nomogram in gastric cancer[J]. World J Surg, 2018, 42(8): 2530-2541.
[9]	Wang LQ, Liang D, Xu XL, et al. The prognostic value of neutrophil to lymphocyte and platelet to lymphocyte ratios for patients with lung cancer[J]. Oncol Lett, 2017, 14(6): 6449-6456. doi: 10.3892/ol.2017.7047 pmid: 29163681
[10]	Liu X, Qu JK, Zhang J, et al. Prognostic role of pretreatment neutrophil to lymphocyte ratio in breast cancer patients: A meta-analysis[J]. Medicine, 2017, 96(45): e8101.
[11]	Laohawiriyakamol S, Mahattanobon S, Laohawiriyakamol S, et al. The pre-treatment neutrophil-lymphocyte ratio: A useful tool in predicting non-sentinel lymph node metastasis in breast cancer cases[J]. Asian Pac J Cancer Prev, 2017, 18(2): 557-562.
[12]	Aoyama T, Takano M, Miyamoto M, et al. Pretreatment neutrophil-to-lymphocyte ratio was a predictor of lymph node metastasis in endometrial cancer patients[J]. Oncology, 2019, 96(5): 259-267. doi: 10.1159/000497184 pmid: 30893700
[13]	Doescher J, Veit JA, Hoffmann TK. The 8th edition of the AJCC Cancer Staging Manual: Updates in otorhinolaryngology, head and neck surgery[J]. HNO, 2017, 65(12): 956-961. doi: 10.1007/s00106-017-0391-3 pmid: 28717958
[14]	Yang L, Wang HB, Ma JP, et al. Association between the platelet to lymphocyte ratio, neutrophil to lymphocyte ratio and axillary lymph node metastasis in cT1N0 breast cancer patients[J]. Am J Transl Res, 2021, 13(3): 1854-1861. pmid: 33841711
[15]	Hamid HKS, Davis GN, Trejo-Avila M, et al. Prognostic and predictive value of neutrophil-to-lymphocyte ratio after curative rectal cancer resection: A systematic review and meta-analysis[J]. Surg Oncol, 2021, 37: 101556.
[16]	Nemoto T, Endo S, Isohata N, et al. Change in the neutrophil-to-lymphocyte ratio during chemotherapy may predict prognosis in patients with advanced or metastatic colorectal cancer[J]. Mol Clin Oncol, 2021, 14(5): 107. doi: 10.3892/mco.2021.2269 pmid: 33815795
[17]	Singh N, Baby D, Rajguru JP, et al. Inflammation and cancer[J]. Ann Afr Med, 2019, 18(3): 121-126. doi: 10.4103/aam.aam_56_18 pmid: 31417011
[18]	Nakamoto S, Ikeda M, Kubo S, et al. Systemic immunity markers associated with lymphocytes predict the survival benefit from paclitaxel plus bevacizumab in HER2 negative advanced breast cancer[J]. Sci Rep, 2021, 11(1): 6328. doi: 10.1038/s41598-021-85948-2 pmid: 33737682
[19]	Uludag SS, Sanli AN, Zengin AK, et al. Systemic inflammatory biomarkers as surrogate markers for stage in colon cancer[J]. Am Surg, 2022, 88(6): 1256-1262.
[20]	Stamatopoulos N, Espada Vaquero M, Leonardi M, et al. Pre-operative classification of molar pregnancy: How good is ultrasound? [J]. Aust N Z J Obstet Gynaecol, 2020, 60(5): 698-703.
[21]	Abrahamsson H, Meltzer S, Hagen VN, et al. Sex disparities in vitamin D status and the impact on systemic inflammation and survival in rectal cancer[J]. BMC Cancer, 2021, 21(1): 535. doi: 10.1186/s12885-021-08260-2 pmid: 33975557
[22]	Acharya S, Rai P, Hallikeri K, et al. Preoperative platelet lymphocyte ratio is superior to neutrophil lymphocyte ratio to be used as predictive marker for lymph node metastasis in oral squamous cell carcinoma[J]. J Investig Clin Dent, 2017, 8(3): e12219-e12226.
[23]	Salzano G, Dell'Aversana Orabona G, Abbate V, et al. The prognostic role of the pre-treatment neutrophil to lymphocyte ratio (NLR) and tumor depth of invasion (DOI) in early-stage squamous cell carcinomas of the oral tongue[J]. Oral Maxillofac Surg, 2022, 26(1): 21-32.
[24]	Tam S, Amit M, Zafereo M, et al. Depth of invasion as a predictor of nodal disease and survival in patients with oral tongue squamous cell carcinoma[J]. Head Neck, 2019, 41(1): 177-184.
[25]	Hwang JE, Hong JY, Kim JE, et al. Prognostic significance of the concomitant existence of lymphovascular and perineural invasion in locally advanced gastric cancer patients who underwent curative gastrectomy and adjuvant chemotherapy[J]. Jpn J Clin Oncol, 2015, 45(6): 541-546.

临床病理特征	M(Q₁，Q₃)/n(%)
NLR	1.88(1.36，2.53)
PLR	108.23(80.15，139.07)
性别
男	89(63.1)
女	52(36.9)
年龄/岁
≤60	94(66.6)
>60	47(33.4)
吸烟
否	75(53.2)
是	66(46.8)
饮酒
否	73(51.8)
是	68(48.2)
高血压
否	102(72.3)
是	39(27.7)
糖尿病
否	124(87.9)
是	17(12.1)
肿瘤最大直径/cm
≤2	55(39.0)
>2，且≤4	66(46.8)
>4	20(14.2)
T分期
T1~T2	97(68.8)
T3~T4	44(31.2)
神经侵犯
否	63(44.7)
是	78(55.3)
血管侵犯
否	82(58.2)
是	59(41.8)
肿瘤分化程度
低、中	59(41.8)
高	82(58.2)
DOI/mm
≤5	52(36.9)
>5，且≤10	52(36.9)
>10	37(26.2)
颈部淋巴结
转移	55(39)
未转移	86(61)

临床病理特征	M(Q₁，Q₃)/n(%)
NLR	1.88(1.36，2.53)
PLR	108.23(80.15，139.07)
性别
男	89(63.1)
女	52(36.9)
年龄/岁
≤60	94(66.6)
>60	47(33.4)
吸烟
否	75(53.2)
是	66(46.8)
饮酒
否	73(51.8)
是	68(48.2)
高血压
否	102(72.3)
是	39(27.7)
糖尿病
否	124(87.9)
是	17(12.1)
肿瘤最大直径/cm
≤2	55(39.0)
>2，且≤4	66(46.8)
>4	20(14.2)
T分期
T1~T2	97(68.8)
T3~T4	44(31.2)
神经侵犯
否	63(44.7)
是	78(55.3)
血管侵犯
否	82(58.2)
是	59(41.8)
肿瘤分化程度
低、中	59(41.8)
高	82(58.2)
DOI/mm
≤5	52(36.9)
>5，且≤10	52(36.9)
>10	37(26.2)
颈部淋巴结
转移	55(39)
未转移	86(61)

指标	颈淋巴结未转移组	颈淋巴结转移组	Z值	P值
NLR	1.61(1.31，2.12)	2.45(1.64，3.36)^①	-4.445	<0.001
PLR	106.59(80.91，139.05)	123.38(94.59，164.12)^①	-2.141	0.032

指标	颈淋巴结未转移组	颈淋巴结转移组	Z值	P值
NLR	1.61(1.31，2.12)	2.45(1.64，3.36)^①	-4.445	<0.001
PLR	106.59(80.91，139.05)	123.38(94.59，164.12)^①	-2.141	0.032

指标	曲线下面积	最佳截断值	约登指数	敏感度/%	特异度/%	P值
NLR	0.72	2.24	0.44	58.2	86.0	<0.05
PLR	0.61	115.43	0.19	56.4	61.6	<0.05

选择文件类型/文献管理软件名称

选择包含的内容