摘要目的 探讨治疗前血液炎性标志物,对食管鳞状细胞癌(ESCC)接受放(化)疗患者治疗效果及生存预后的影响.方法 回顾性分析2013年1月至2014年12月在扬州大学附属泰兴人民医院行根治性放疗(RT)或放化疗(CRT)的107例ESCC患者,根据治疗前中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)和C反应蛋白与白蛋白比值(CRP/Alb)的中位值将患者分为NLR＜3.06组(54例)和NLR≥3.06组(53例),PLR＜ 145.26组(54例)与PLR≥145.26组(53例),CRP/Alb＜0.13组(52例)和CRP/Alb≥0.13组(55例),治疗效果采用logistic回归分析;生存预后采用Kaplan-Meier法计算无疾病进展生存率并用Log-rank法检验,Cox模型多因素分析.结果 放化疗、NLR＜3.06组、PLR＜ 145.26组和CRP/Alb＜0.13组患者的治疗效果分别优于单纯放疗、NLR≥3.06、PLR≥145.26和CRP/Alb≥0.13患者,差异均有统计学意义(HR=2.118、4.138、2.297、3.784,P＜0.05);进一步分析显示放化疗(HR=1.342,95％ CI 1.023～2.467,P＜0.05)与CRP/Alb＜0.13(HR=7.004,95％CI 2.088～23.496,P＜0.05)是疗效好的独立危险因素.另外,单因素Cox回归分析显示,TNM分期、治疗方式、NLR、PLR和CRP/Alb均与食管鳞癌患者的无疾病进展生存时间(PFS)密切相关(P＜0.05);在多因素COX回归模型中显示:TNM分期(HR=1.326,95％CI 1.070～1.838,P＜ 0.05)、治疗方式(HR=0.400,95％ CI 0.230～0.694,P＜0.05)与CRP/Alb(HR=3.518;95％CI 1.975～6.266;P＜0.05)是无进展生存(PFS)的独立预后因素.而根据TNM分期及治疗方式的亚组分析得出无论在食管鳞癌的早期患者(Ⅰ+Ⅱ期),还是晚期患者(Ⅲ期),是接受单纯放疗,还是同步放化疗,CRP/Alb＜0.13的无疾病进展生存时间均优于CRP/Alb≥0.13.最后,受试者工作特征(ROC)曲线也证实CRP/Alb在预测食管鳞癌接受放化疗患者的近期疗效和无疾病进展生存时间方面优于NLR和PLR.结论 血液炎性指标CRP/Alb在预测胸段食管鳞状细胞癌接受放(化)疗患者近期疗效及生存预后方面具有重要价值.

abstractsObjective The purpose of this study was to investigate the influence of pre-treatment inflammatory markers on the therapeutic effect and survival outcome in patients with esophageal squamous cell carcinoma (ESCC) who received chemoradiotherapy (CRT) or radiotherapy (RT) alone.Methods A total of 107 patients who were diagnosed with ESCC were retrospectively analysed.They were treated with radical radiotherapy alone or concurrent chemoradiotherapy in the Affiliated Taixing People's Hospital of Yangzhou University between January 2013 and December 2014.According to the median values of neutrophil-lymphocyte ratio (NLR),platelet-lymphocyte ratio (PLR) and CRP/Alb ratio before treatment,the patients were divided into NLR＜3.06 group (54 cases) and NLR≥3.06 group (53 cases),PLR＜145.26 group (54 cases) and PLR≥ 145.26 (53 cases),CRP/Alb＜0.13 group (52 cases) and CRP/Alb≥0.13 (55 cases),respectively.The relationships between the response to treatment and these markers were analysed by univariate and multivariate logistic analyses.The Kaplan-Meier method and logrank test were adopted to calculate and compare associations of the progression-free survival (PFS) rates with these blood markers.Cox proportional hazards models were used for the univariate and multivariate analyses.Results The therapeutic effects of chemoradiotherapy,NLR＜3.06,PLR＜ 145.26 and CRP/ Alb＜ 0.13 were better than those of radiotherapy alone,NLR≥ 3.06,PLR≥ 145.26 and CRP/Alb ≥ 0.13,respectively,and the differences were statistically significant (HR=2.118,4.138,2.297,3.784,P＜0.05).Further analysis showed that chemoradiotherapy (HR =1.342,95％ CI 1.023 ～ 2.467,P＜ 0.05) and CRP/Alb ratio＜ 0.13 (HR =7.004,95％ CI 2.088 ～ 23.496,P＜0.05) were independent risk factors for good tumour response.In addition,TNM stage,treatment modality,NLR,PLR and CRP/Alb ratio were significantly associated with PFS by the univariate analysis (P＜0.05 for all).Furthermore,the multivariate Cox proportional hazard regression model analysis showed that only TNM stage (HR =1.326,95％ CI 1.070-1.833 P＜0.05),treatment modality (HR =0.400,95％ CI 0.230-0.694,P＜0.05) and CRP/Alb ratio (HR=3.518,95％ CI 1.975-6.266,P＜ 0.05) were considered independent prognostic factors for PFS.And according to TNM staging and treatment subgroup analysis,CRP/Alb＜0.13 had better progression-free survival time than CRP/Alb≥ 0.13 ESCC patients.Finally,the ROC curve also confirmed that CRP/Alb was superior to NLR and PLR in predicting short-term efficacy and progression-free survival in ESCC patients receiving chemoradiotherapy.Conclusions Our study demonstrated that CRP/Alb ratio was promising as a predictive marker for the therapeutic effect and survival outcome in ESCC patients receiving CRT or RT alone.