CAJ | 학술논문

目的：评价术前外周血中性粒细胞/淋巴细胞比值（neutrophit-to-lymphocyte ratio，NLR），对上皮性卵巢癌患者预后的预测意义。方法：回顾性分析天津医科大学肿瘤医院80例上皮性卵巢癌患者的临床病理资料，通过建立受试者工作特征曲线（ROC曲线），确定术前外周血NLR预测术后生存的最佳截点，以此将患者分为低NLR和高NLR两组，分析NLR与患者的临床病理特征之间的关系，并通过单因素及多因素分析评估术前外周血NLR对患者术后生存的影响。通过免疫组织化学法验证术前NLR与肿瘤相关巨噬细胞浸润的关系。结果：术前NLR预测患者术后生存时间的最佳截点为3.8。术前低NLR组（NLR≤3.8）与高NLR组（NLR>3.8）患者在FIGO分期的差异有统计学意义（P<0.005），而在其他的各项临床病理特征间差异均无统计学意义。80例上皮性卵巢癌术后中位生存时间为45个月，术后1、3年生存率分别为93.7%、60.0%。单因素分析结果显示：术前NLR>3.8（P<0.005）及术后FIGO分期为Ⅲ～Ⅳ期（P<0.005）是影响患者术后总体生存以及无瘤生存期的危险因素。多因素分析显示：术前NLR>3.8（P<0.05）及术后FIGO分期为Ⅲ～Ⅳ期（P<0.05）为上皮性卵巢癌患者术后预后不良的独立危险因素。免疫组织化学法表明肿瘤相关巨噬细胞在术前高NLR组54.65±8.78与低NLR组41.78±9.10之间的差异有统计学意义（P<0.001）。结论：术前NLR升高提示患者预后不良，是影响上皮性卵巢癌患者预后的独立危险因素。
목적：평개술전외주혈중성립세포/림파세포비치（neutrophit-to-lymphocyte ratio，NLR），대상피성란소암환자예후적예측의의。방법：회고성분석천진의과대학종류의원80례상피성란소암환자적림상병리자료，통과건립수시자공작특정곡선（ROC곡선），학정술전외주혈NLR예측술후생존적최가절점，이차장환자분위저NLR화고NLR량조，분석NLR여환자적림상병리특정지간적관계，병통과단인소급다인소분석평고술전외주혈NLR대환자술후생존적영향。통과면역조직화학법험증술전NLR여종류상관거서세포침윤적관계。결과：술전NLR예측환자술후생존시간적최가절점위3.8。술전저NLR조（NLR≤3.8）여고NLR조（NLR>3.8）환자재FIGO분기적차이유통계학의의（P<0.005），이재기타적각항림상병리특정간차이균무통계학의의。80례상피성란소암술후중위생존시간위45개월，술후1、3년생존솔분별위93.7%、60.0%。단인소분석결과현시：술전NLR>3.8（P<0.005）급술후FIGO분기위Ⅲ～Ⅳ기（P<0.005）시영향환자술후총체생존이급무류생존기적위험인소。다인소분석현시：술전NLR>3.8（P<0.05）급술후FIGO분기위Ⅲ～Ⅳ기（P<0.05）위상피성란소암환자술후예후불량적독립위험인소。면역조직화학법표명종류상관거서세포재술전고NLR조54.65±8.78여저NLR조41.78±9.10지간적차이유통계학의의（P<0.001）。결론：술전NLR승고제시환자예후불량，시영향상피성란소암환자예후적독립위험인소。
Objective:This study aims to evaluate the effect of an elevated preoperative neutrophil to lymphocyte ratio (NLR) on outcome after comprehensive staging laparotomy or optimal tumor debulking surgery for epithelial ovarian cancer (EOC) and determine the value of the NLR as an independent prognostic prediction marker. Methods:A total of 80 women with primary EOC and with complete clinical and pathological information documented at the time of surgery were selected for this study. The optimum cut-off value of the preoperative NLR was identified through receiver operator characteristic (ROC) curve, and the patients were then classified into two groups: low and high NLR group. Univariate and multivariate analyses were performed to assess the prognostic effect of the preoperative NLR patients who underwent comprehensive staging laparotomy or optimal tumor debulking surgery. The levels of expression of CD68 were measured through immunohistochemistry. Results:The optimal cut-off value of the NLR was 3.8. The preoperative NLR differed significantly in the FIGO stage between the low NLR group (NLR ≤3.8) and the high NLR group (NLR>3.8), but no discrimination was observed in other parameters. The mean follow-up time was 45 months, and the post-operative 1-and 3-year survival rates were 93.7%and 60.0%, respectively. The preoperative NLR>3.8 and stageⅢ/Ⅳwere all risk factors for poor overall and disease-free survival. Multivariate analysis revealed the patients with high NLR (P<0.05) and stage Ⅲ/Ⅳ (P<0.05) had prognostic significance for poor overall survival. The number of CD68-positive tumor-associated macrophages was significantly higher in the high NLR group than in the low NLR group (54.65 ± 8.78 and 41.78 ± 9.10, respectively; P<0.001). Conclusion: An elevated blood preoperative NLR indicates poor prognosis in patients with EOC. Preoperative NLR may function as an important independent prognostic factor for patients with EOC.