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中华妇幼临床医学杂志(电子版) ›› 2017, Vol. 13 ›› Issue (05) : 532 -538. doi: 10.3877/cma.j.issn.1673-5250.2017.05.006

所属专题： 文献；

论著

单核细胞与淋巴细胞比值及其与上皮性卵巢癌患者预后的关系
唐英1, 李均2, 徐凡2, 胡辉权2,†()   
  1. 1. 637000　四川南充，川北医学院第二临床医学院妇科；637000　四川南充，川北医学院
    2. 637000　四川南充，川北医学院第二临床医学院妇科
  • 收稿日期:2017-06-24 修回日期:2017-08-19 出版日期:2017-10-01
  • 通信作者: 胡辉权

Association between monocyte-to-lymphocyte ratio and prognosis of patients with epithelial ovarian cancer

Ying Tang1, Jun Li2, Fan Xu2, Huiquan Hu2,†()   

  1. 1. Department of Gynecology, Second Clinical School of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China；North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
    2. Department of Gynecology, Second Clinical School of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
  • Received:2017-06-24 Revised:2017-08-19 Published:2017-10-01
  • Corresponding author: Huiquan Hu
  • About author:
    Corresponding author: Hu Huiquan, Email:
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引用本文：

唐英, 李均, 徐凡, 胡辉权. 单核细胞与淋巴细胞比值及其与上皮性卵巢癌患者预后的关系[J/OL]. 中华妇幼临床医学杂志(电子版), 2017, 13(05): 532-538.

Ying Tang, Jun Li, Fan Xu, Huiquan Hu. Association between monocyte-to-lymphocyte ratio and prognosis of patients with epithelial ovarian cancer[J/OL]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2017, 13(05): 532-538.

目的

探讨单核细胞与淋巴细胞比值(MLR)及其与上皮性卵巢癌(EOC)患者预后的关系。

方法

选择2005年1月至2015年1月，于川北医学院第二临床医学院接受治疗的214例初治EOC患者为研究对象。采用回顾性分析方法，采集所有受试者的临床病例资料。绘制MLR预测EOC患者总体生存(OS)期的受试者工作特征(ROC)曲线，确定MLR预测EOC患者OS期的最佳临界值，并按照MLR最佳临界值，对EOC患者进行分组。统计学比较其临床病理特征和OS期。采用单因素和多因素Cox回归分析方法，对可能影响EOC患者OS期的因素进行分析。

结果

①根据MLR预测EOC患者OS期的ROC曲线，MLR预测EOC患者OS期的最佳临界值为0.26。按照MLR最佳临界值，将纳入研究的214例EOC患者分为高MLR组(n＝128，MLR≥0.26)和低MLR组(n＝86，MLR<0.26)。2组患者年龄、体重、人体质量指数(BMI)等基本临床资料比较，差异均无统计学意义(P>0.05)。②高MLR组患者年龄≥62岁、EOC组织病理学类型为浆液性卵巢癌、国际妇产科联盟(FIGO)临床分期为Ⅲ～Ⅳ期所占比例，患者病死率，以及血清糖类抗原125(CA125)水平、白细胞计数、中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)，均显著高于低MLR组，并且差异均有统计学意义(P<0.05)。2组患者满意卵巢癌细胞减灭术及合并腹水所占比例，以及血红蛋白水平分别比较，差异均无统计学意义(P>0.05)。③低MLR组EOC患者的中位OS期为87个月，显著长于高MLR组的38个月，二者比较，差异有统计学意义(χ2＝67.166，P<0.001)。④EOC患者OS期影响因素的多因素Cox回归分析结果显示，FIGO临床分期为Ⅲ～Ⅳ期、EOC组织病理学类型为浆液性卵巢癌、非满意卵巢癌细胞减灭术、血清CA125水平≥35 U/mL、MLR≥0.26、NLR、PLR，均为EOC患者OS期的独立危险因素(HR＝8.370，95%CI：5.094～13.753，P<0.001；HR＝1.851，95%CI：1.171～2.924，P＝0.008；HR＝0.345，95%CI：0.234～0.507，P<0.001；HR＝2.434，95%CI：1.538～3.851，P<0.001；HR＝3.364，95%CI：2.145～5.276，P<0.001；HR＝1.106，95%CI：1.020～1.199，P＝0.015；HR＝0.998，95%CI：0.996～1.000，P＝0.021)。

结论

MLR可作为EOC患者预后的预测指标。因本研究为回顾性研究，纳入样本量相对较小，MLR预测EOC患者预后的真实性和准确性，仍有待多中心、大样本、随机对照研究证实。

关键词: 上皮性卵巢癌, 单核细胞/淋巴细胞比值, 预后, 妇女
Objective

To explore the association between monocyte-to-lymphocyte ratio (MLR) and prognosis of patients with epithelial ovarian cancer (EOC).

Methods

A total of 214 patients with EOC who underwent initial surgical resection between January 2005 to January 2015 in Second Clinical Medical College of North Sichuan Medical College were selected as research subjects. Clinical data of all subjects were collected by retrospective analysis. The receiver operating characteristic (ROC) curve of MLR predicting overall survival (OS) time in patients with EOC was drawn. The optimal cut-off value of MLR predicting OS time in patients with EOC was determined by ROC curve, and the EOC patients were categorized into two group according to the optimal cut-off value of MLR. The clinicopathological features and OS time of the 2 groups were compared statistically. Univariate and multivariate Cox regression analysis was used to analyze the factors that might affect OS time in patients with EOC.

Results

①According to the ROC curve of MLR predicting OS time in patients with EOC, the optimal cut-off value of MLR predicting OS time in patients with EOC was 0.26. Accordingly, all the 214 EOC patients were categorized into the high MLR group (n=128, MLR≥0.26) and low MLR group (n=86, MLR<0.26). There were no significant differences between two groups in the age, weight, body mass index (BMI) (P>0.05). ②The rates of patients with ≥62 years old, serous ovarian cancer histopathological type, Federation International of Gynecology and Obstetrics (FIGO) stage Ⅲ-Ⅳ, the fatality rate, and the serum carbohydrate antigen 125 (CA125) level, white blood cell count, neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in high MLR group all were higher those in low MLR group, and all the differences were statistically significant (P<0.05). There were no significant differences between 2 groups in the rates of satisfactory ovarian cancer cytoreductive surgery and combined with ascites, and hemoglobin level (P>0.05). ③The OS time of low MLR group was 87 months, which was obviously longer than that of high MLR group 38 months, and the difference was statistically significant (χ2=67.166, P<0.001). ④The multivariate Cox analysis results showed that FIGO stage Ⅲ-Ⅳ, serous ovarian cancer histopathological type, non-satisfactory ovarian cancer cytoreductive surgery, serum CA125 level≥35 U/mL, MLR≥0.26, NLR and PLR all were independent risk factors of OS time in EOC patients (HR=8.370, 95%CI: 5.094-13.753, P<0.001; HR=1.851, 95%CI: 1.171-2.924, P=0.008; HR=0.345, 95%CI: 0.234-0.507, P<0.001; HR=2.434, 95%CI: 1.538-3.851, P<0.001; HR=3.364, 95%CI: 2.145-5.276, P<0.001; HR=1.106, 95%CI: 1.020-1.199, P=0.015; HR=0.998, 95%CI: 0.996-1.000, P=0.021).

Conclusions

MLR is an independent prognostic factor affecting the survival of patients with EOC. Since this study is a retrospective study and the sample size is relatively small, the authenticity and accuracy of MLR predicting the prognosis of EOC patients should be confirmed by multicenter, large sample and randomized controlled studies.

Key words: Epithelial ovarian cancer, Monocyte-to-lymphocyte ratio, Prognosis, Women
图1 单核细胞与淋巴细胞比值预测上皮性卵巢癌患者总体生存期的受试者工作特征曲线
表1 低MLR组与高MLR组上皮性卵巢癌患者的临床病理学特征比较
组别 例数 年龄[例数(%)] 组织病理学类型[例数(%)] FIGO临床分期[例数(%)] 满意卵巢癌细胞减灭术[例数(%)] 血清CA125水平[U/mL，M(P25～P75)]
≥62岁 <62岁 浆液性卵巢癌 其他类型 Ⅰ～Ⅱ期 Ⅲ～Ⅳ期 是 否
低MLR组 86 14(16.3) 72(83.7) 55(64.0) 31(36.0) 56(65.1) 30(34.9) 39(45.3) 47(54.7) 95.7(28.5～305.3)
高MLR组 128 34(26.6) 94(73.4) 91(71.1) 37(28.9) 43(33.6) 85(66.4) 57(44.5) 71(55.5) 284.3(107.6～2 889.7)
检验值 ? χ2＝5.304 χ2＝4.644 χ2＝19.312 χ2＝0.014 Z＝－5.063
P值 ? 0.021 0.031 <0.001 0.906 <0.001
组别 例数 合并腹水[例数(%)] 随访结局[例数(%)] 血红蛋白水平(g/L，±s) 白细胞计数(×109/L，±s) NLR[M(P25～P75)] PLR[M(P25～P75)]
是 否 病死率 存活率
低MLR组 86 31(36.0) 55(64.0) 30(34.9) 56(65.1) 113.2±18.4 7.0±2.1 2.4(1.8～3.2) 131.5(107.5～168.6)
高MLR组 128 47(36.7) 81(63.3) 109(85.2) 19(14.8) 113.9±21.0 7.9±2.4 4.2(2.6～6.3) 200.0(151.1～312.0)
检验值 ? χ2＝0.010 χ2＝57.109 t＝－0.279 t＝3.104 Z＝－6.012 Z＝－6.611
P值 ? 0.920 <0.001 0.781 0.002 <0.001 <0.001
图2 2组上皮性卵巢癌患者总体生存曲线比较
表2 上皮性卵巢癌患者总体生存期影响因素的Cox回归分析的变量含义及其赋值
自变量/因变量 变量名 赋值
OS期 y 表示患者接受卵巢癌细胞减灭术后第1天至死亡或本研究设定的随访截止时间
年龄 x1 x1＝0表示患者年龄<62岁，x1＝1表示患者年龄≥62岁
FIGO临床分期 x2 x2＝0表示FIGO临床分期为Ⅰ～Ⅱ期，x2＝1表示FIGO临床分期为 Ⅲ～Ⅳ期
组织病理学类型 x3 x3＝0表示除浆液性卵巢癌外的其他组织病理学类型，x3＝1表示浆液性卵巢癌
是否为满意卵巢癌细胞减灭术 x4 x4＝0表示非满意卵巢癌细胞减灭术，x4＝1表示满意卵巢癌细胞减灭术
是否合并腹水 x5 x5＝0表示未合并腹水，x5＝1表示合并腹水
血清CA125水平 x6 x6＝0表示血清CA125水平<35 U/mL，x6＝1表示血清CA125水平≥35 U/mL
血红蛋白水平 x7 x7表示实际血红蛋白水平
白细胞计数 x8 x8＝0表示白细胞计数<8.16×109/L，x8＝1表示白细胞计数≥8.16×109/L
MLR x9 x9＝0表示MLR<0.26，x9＝1表示MLR≥0.26
NLR x10 x10表示实际NLR
PLR x11 x11表示实际PLR
表3 上皮性卵巢癌患者总体生存期影响因素的单因素Cox回归分析结果
影响因素 B SE Wald值 P值 HR值 HR值95%CI
年龄 0.646 0.183 12.488 <0.001 1.907 1.333～2.729
FIGO临床分期 2.253 0.229 96.955 <0.001 9.520 6.079～14.909
组织病理学类型 0.685 0.192 12.692 <0.001 1.983 1.361～2.891
是否为满意卵巢癌细胞减灭术 －0.590 0.174 11.493 0.001 0.554 0.394～0.780
是否合并腹水 0.955 0.179 28.485 <0.001 2.599 1.830～3.691
血清CA125水平 0.876 0.266 10.817 0.001 0.001 1.424～4.045
血红蛋白水平 －0.002 0.004 0.245 0.620 0.998 0.990～1.006
白细胞计数 0.081 0.032 6.375 0.012 1.084 1.018～1.154
MLR 1.623 0.221 54.037 <0.001 5.070 3.289～7.816
NLR 0.144 0.025 32.820 <0.001 1.155 1.099～1.213
PLR 0.002 0.001 21.606 <0.001 1.002 1.001～1.004
表4 上皮性卵巢癌患者总体生存期影响因素的多因素Cox回归分析结果
影响因素 B SE Wald值 P值 HR值 HR值95%CI
年龄 2.620 0.192 1.858 0.173 1.299 0.892～1.893
FIGO分期 2.125 0.253 70.305 <0.001 8.370 5.094～13.753
组织病理学类型 0.615 0.233 6.951 0.008 1.851 1.171～2.924
是否为满意卵巢癌细胞减灭术 －1.065 0.194 29.331 <0.001 0.345 0.234～0.507
是否合并腹水 0.357 0.184 3.774 0.052 1.429 0.997～2.049
血清CA125水平 0.889 0.234 14.423 <0.001 2.434 1.538～3.851
MLR 1.213 0.230 27.912 <0.001 3.364 2.145～5.276
NLR 0.101 0.041 5.933 0.015 1.106 1.020～1.199
PLR －0.002 0.001 5.294 0.021 0.998 0.996～1.000
[1]
Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015[J]. CA Cancer J Clin, 2016, 66(2): 115-132.
[2]
Horala A, Swiatly A, Matysiak J, et al. Diagnostic value of serum angiogenesis markers in ovarian cancer using multiplex immunoassay[J]. Int J Mol Sci, 2017, 18(1): 123.
[3]
Lin R, Chen L, Chen G, et al. Targeting miR-23a in CD8＋ cytotoxic T lymphocytes prevents tumor-dependent immunosuppression[J]. J Clin Invest, 2014, 124(12): 5352-5367.
[4]
Liang J, Piao Y, Holmes L, et al. Neutrophils promote the malignant glioma phenotype through S100A4[J]. Clin Cancer Res, 2014, 20(1): 187-198.
[5]
Xiang J, Zhou L, Li X, et al. Preoperative monocyte-to-lymphocyte ratio in peripheral blood predicts stages, metastasis, and histological grades in patients with ovarian cancer[J]. Transl Oncol, 2017, 10(1): 33-39.
[6]
Lucca I, de Martino M, Hofbauer SL, et al. Comparison of the prognostic value of pretreatment measurements of systemic inflammatory response in patients undergoing curative resection of clear cell renal cell carcinoma[J]. World J Urol, 2015, 33(12): 2045-2052.
[7]
Giuliani M, Sampson LR, Wong O, et al. Prognostic value of pretreatment circulating neutrophils, monocytes, and lymphocytes on outcomes in lung stereotactic body radiotherapy[J]. Curr Oncol, 2016, 23(4): e362-e368.
[8]
Feng F, Tian Y, Liu S, et al. Combination of PLR, MLR, MWR, and tumor size could significantly increase the prognostic value for gastrointestinal stromal tumors[J]. Medicine (Baltimore), 2016, 95(14): e3248.
[9]
谢幸，苟文丽，主编. 妇产科学. 8版[M]. 北京：人民卫生出版社，2013: 321-328.
[10]
Therasse P, Arbuck SG, Eisenhauer EA, et al. New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada[J]. J Natl Cancer Inst, 2000, 92(3): 205-216.
[11]
Eo WK, Chang HJ, Kwon SH, et al. The lymphocyte-monocyte ratio predicts patient survival and aggressiveness of ovarian cancer[J]. J Cancer, 2016, 7(3): 289-296.
[12]
Balkwill F, Mantovani A. Inflammation and cancer: back to Virchow？[J]. Lancet, 2001, 357( 9255): 539-545.
[13]
Zhang X, Zhang W, Yuan X, et al. Neutrophils in cancer development and progression: roles, mechanisms, and implications (review)[J]. Int J Oncol, 2016, 49(3): 857-867.
[14]
Hase S, Weinitschke K, Fischer K, et al. Monitoring peri-operative immune suppression in renal cancer patients[J]. Oncol Rep, 2011, 25(5): 1455-1464.
[15]
Yigit S, Demir L, Tarhan MO, et al. The clinicopathological significance of Bax and Bcl-2 protein expression with tumor infiltrating lymphocytes in ovarian carcinoma[J]. Neoplasma, 2012, 59(5): 475-485.
[16]
Li J, Wang J, Chen R, et al. The prognostic value of tumor-infiltrating T lymphocytes in ovarian cancer[J]. Oncotarget, 2017, 8(9): 15621-15631.
[17]
Yang J, Zhang L, Yu C, et al. Monocyte and macrophage differentiation: circulation inflam-matory monocyte as biomarker for inflammatory diseases[J]. Biomark Res, 2014, 2(1): 1.
[18]
Szebeni GJ, Vizler C, Kitajka K, et al. Inflammation and cancer: extra- and intracellular determinants of tumor-associated macrophages as tumor promoters[J]. Mediators Inflamm, 2017, 2017: 9294018.
[19]
Zhu Q, Wu X, Wang X. Differential distribution of tumor-associated macrophages and Treg/Th17 cells in the progression of malignant and benign epithelial ovarian tumors[J]. Oncol Lett, 2017, 13(1): 159-166.
[20]
Yin M, Li X, Tan S, et al. Tumor-associated macrophages drive spheroid formation during early transcoelomic metastasis of ovarian cancer[J]. J Clin Invest, 2016, 126(11): 4157-4173.
[21]
Paik ES, Shim M, Choi HJ, et al. Preoperative multiplication of neutrophil and monocyte counts as a prognostic factor in epithelial ovarian cancer[J]．Cancer Biomark, 2016, 17(4): 419-425.
[22]
王秀娟，苑中甫，邱海峰，等. 术前外周血淋巴细胞/单核细胞比值与上皮性卵巢癌患者预后的关系[J]. 现代妇产科进展，2016, 25(9): 654-657.
[23]
Auer K, Bachmayr-Heyda A, Aust S, et al. Peritoneal tumor spread in serous ovarian cancer-epithelial mesenchymal status and outcome[J]. Oncotarget, 2015, 6(19): 17261-17275.
[24]
Zhang Z, Huang J, Zhang C, et al. Infiltration of dendritic cells and T lymphocytes predicts favorable outcome in epithelial ovarian cancer[J]. Cancer Gene Ther, 2015, 22(4): 198-206.
[25]
Kim HS, Choi HY, Lee M, et al. Systemic inflammatory response markers and CA-125 levels in ovarian clear cell carcinoma: a two center cohort study[J]. Cancer Res Treat, 2016, 48(1): 250-258.
[26]
Xiang J, Zhou L, Li X, et al. Preoperative monocyte-to-lymphocyte ratio in peripheral blood predicts stages, metastasis, and histological grades in patients with ovarian cancer[J]. Transl Oncol, 2017, 10(1): 33-39.
[27]
Li Z, Hong N, Robertson M, et al. Preoperative red cell distribution width and neutrophil-to-lymphocyte ratio predict survival in patients with epithelial ovarian cancer[J]. Sci Rep, 2017, 7: 43001.
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