国际肿瘤学杂志

国际肿瘤学杂志 ›› 2018, Vol. 45 ›› Issue (12): 711-715.doi: 10.3760/cma.j.issn.1673-422X.2018.12.002

• 论著 • 上一篇    下一篇

Ki67和衍生中性粒细胞与淋巴细胞比值 对鼻咽癌患者的预后评估

徐翔,何庆文,肖才文   

  1. 430030 江汉大学附属武汉市第六医院耳鼻喉科
  • 出版日期:2018-12-08 发布日期:2019-02-01
  • 通讯作者: 徐翔 E-mail:whslyyent@163.com

Prognostic evaluation of Ki67 and derived neutrophil-lymphocyte ratio in patients with nasopharyngeal carcinoma

Xu Xiang, He Qingwen, Xiao Caiwen   

  1. Department of Otolaryngology, Sixth Hospital of Wuhan Affiliated to Jianghan University, Wuhan 430030, China
  • Online:2018-12-08 Published:2019-02-01
  • Contact: Xu Xiang E-mail:whslyyent@163.com

PDF

797

摘要： 目的探讨Ki67和衍生中性粒细胞与淋巴细胞比值（dNLR）与鼻咽癌患者临床预后的关系。方法纳入2011年1月至2015年6月我院收治的180例病理确诊的未分化型鼻咽癌患者，收集患者接受放化疗前的中性粒细胞计数、白细胞计数，并计算dNLR。同时通过免疫组织化学检测鼻咽癌患者肿瘤组织的Ki67阳性率，并评估Ki67阳性率和dNLR对鼻咽癌患者总生存（OS）率和无进展生存（PFS）率的预测价值。结果通过受试者工作特征（ROC）曲线计算Ki67和dNLR对鼻咽癌患者的3年OS率预测阈值分别为73.5%和2.21。Ki67≥73.5%患者的TNM Ⅲ~Ⅳ期比例高于Ki67<73.5%患者（100%∶89.7%，χ2=5.529，P=0.019）；dNLR≥2.21患者的T34期比例高于dNLR<2.21患者（91.1%∶75.0%，χ2=6.228，P=0.013），并且dNLR≥2.21患者的TNM Ⅲ~Ⅳ期比例高于dNLR<2.21患者（100%∶90.3%，χ2=4.355，P=0.037），差异均具有统计学意义。多因素Cox回归分析提示Ki67≥73.5%（HR=3.011，95%CI为1.874~4.982，P<0.001）和dNLR≥2.21（HR=2.234，95%CI为1.274~3.382，P=0.001）是影响鼻咽癌患者OS的独立危险因素，同时Ki67≥73.5%（HR=2.842，95%CI为2.055~4.337，P<0.001）和dNLR≥2.21（HR=2.086，95%CI为1.452~2.983，P<0.001）也是影响鼻咽癌患者PFS的独立危险因素。联合Ki67和dNLR将患者分为高风险组、中等风险组和低风险组，其3年OS率分别为20.0%、85.7%、95.3%，3年PFS率分别为12.0%、78.6%、89.4%，差异具有统计学意义（χ2=15.521，P<0.001；χ2=15.849，P<0.001）。结论鼻咽癌患者化放疗前的Ki67和dNLR能够有效预测鼻咽癌患者的OS和PFS，联合Ki67和dNLR能够对鼻咽癌患者进行预后分层。

关键词: 鼻咽肿瘤, 预后, 衍生中性粒细胞与淋巴细胞比值, Ki67

Abstract: ObjectiveTo investigate the prognostic value of Ki67 and derived neutrophil to lymphocyte ratio (dNLR) in clinical outcomes of patients with nasopharyngeal carcinoma. MethodsA total of 180 patients with undifferentiated nasopharyngeal carcinoma confirmed by pathology from January 2011 to June 2015 in our hospital were enrolled. The neutrophil count and  white blood cell count before radiotherapy and chemotherapy were collected,  and dNLR was calculated. The positive rate of Ki67 in tumor tissues was detected by immunohistochemistry. The predictive values of  Ki67 positive rate and  dNLR on  the overall survival (OS) rate and progression free survival (PFS) rate were evaluated. ResultsThe 3year OS rate prediction thresholds for patients with nasopharyngeal carcinoma by Ki67 and dNLR were 73.5% and 2.21, respectively, which assessed by receiver operating characteristic (ROC) curve. The proportion of TNM ⅢⅣ stage in patients with Ki67≥73.5% was higher than that in Ki67<73.5% (100% vs. 89.7%, χ2=5.529, P=0.019); the proportion of T34 stage in dNLR≥2.21 was higher than that in dNLR<2.21 (91.1% vs. 75.0%, χ2=6.228, P=0.013), and the proportion of TNM ⅢⅣ stage in the dNLR≥2.21 group was higher than that in the dNLR<2.21 group (100% vs. 90.3%, χ2=4.355, P=0.037). Multivariate Cox regression analysis indicated that Ki67≥73.5% (HR=3.011, 95%CI: 1.8744.982, P<0.001) and dNLR≥2.21 (HR=2.234, 95%CI: 1.2743.382, P=0.001) were independent risk factors for OS in patients with nasopharyngeal carcinoma, while Ki67≥73.5% (HR=2.842, 95%CI: 2.0554.337, P<0.001) and dNLR≥2.21 (HR=2.086, 95%CI: 1.4522.983, P<0.001) were also independent risk factors for PFS in patients with nasopharyngeal carcinoma. Patients were divided into highrisk group, mediumrisk group and lowrisk group combined with Ki67 and dNLR, the 3year OS rates were 20.0%, 85.7% and 95.3% respectively, and the 3year PFS rates were 12.0%, 78.6% and 89.4% respectively,  with  statistical differences (χ2=15.521, P<0.001; χ2=15.849, P<0.001). ConclusionKi67 and dNLR can effectively predict OS and PFS in patients with nasopharyngeal carcinoma, combined with Ki67 and dNLR can prognose stratification of patients with nasopharyngeal carcinoma.

Key words: Nasopharyngeal neoplasms, Prognosis;, Ratio of derived neutrophils to lymphocytes, Ki67