背景:头颈部鳞状细胞癌(HNSCC)患者经常发展为同步食管癌(ESCC),但缺乏临床预测因子。中性粒细胞对淋巴细胞(NLR),血小板淋巴细胞(PLR),和淋巴细胞与单核细胞的比率(LMR),反映了促癌炎症和抗癌免疫反应之间的平衡,但它们在HNSCC和同步癌症中的作用仍不确定。
方法:本研究连续纳入717例新诊断的HNSCC患者,这些患者接受了治疗前食管内镜筛查。预处理NLR,计算LMR和PLR,并与临床因素进行比较分析。
结果:共发现103名患者(14.4%)患有同步ESCC,并与显著较低的绝对淋巴细胞计数相关(p<0.001),较高的NLR(p=0.044)和较低的LMR(p=0.001),但不是PLR(p=0.49)。同步ESCC存在的ROC曲线验证了最佳截止值,NLR为2.5,LMR为4.0。多变量逻辑回归显示LMR<4(OR2.22;95%CI1.27-3.88,p=0.005),饮酒(OR4.19;95%CI1.47-11.91,p=0.007),咽部肿瘤位置(OR1.68;95%CI1.07-2.64,p=0.025),和低体重指数(OR0.94;95%CI0.88-0.99,p=0.039)是发生同步ESCC的危险因素。低LMR与总生存率下降显著相关(p<0.0001),在同步和非同步组中。多变量分析表明LMR<4(HR1.97;95%CI1.38-2.81,p<0.001),低BMI(HR0.96;95%CI0.93-0.99,p=0.044)和存在同步ESCC(HR1.56;95%CI1.10-2.22,p=0.013)是HNSCC患者的独立预后因素.
结论:将LMR纳入其他已确定的风险因素,比如饮酒,肿瘤在咽部的位置,低BMI,可以为HNSCC患者的食管探查建立更有效的筛查计划。LMR的意义还表明,抗癌免疫可能在肿瘤癌变中发挥作用,引发多种癌症,而免疫治疗在未来可能具有预防或辅助治疗同步SCC的潜力.
Patients with head and neck squamous cell carcinoma (HNSCC) frequently develop synchronous esophageal cancer (ESCC), but there is a lack of clinical predictors. The neutrophil to lymphocyte (NLR), platelet to lymphocyte (PLR), and lymphocyte to monocyte ratios (LMRs), reflect the balance between pro-cancer inflammation and anti-cancer immune responses, but their role in HNSCC and synchronous cancer remain uncertain.
The study consecutively enrolled a total of 717 patients with newly diagnosed HNSCC who received pre-treatment esophageal endoscopic screening. The pretreatment NLR, LMR and PLRs were calculated and analyzed in comparison with the clinical factors.
A total of 103 patients (14.4%) were found to have synchronous ESCCs, and were associated with a significantly lower absolute lymphocyte count (p < 0.001), higher NLRs (p = 0.044) and lower LMRs (p = 0.001), but not PLRs (p = 0.49). The ROC curve for the presence of synchronous ESCC verified the optimal cutoff value as 2.5 for NLRs and 4.0 for LMRs. Multivariable logistic regression revealed that a LMR <4 (OR 2.22; 95% CI 1.27-3.88, p = 0.005), alcohol consumption (OR 4.19; 95% CI 1.47-11.91, p = 0.007), tumor location over the pharynx (OR 1.68; 95% CI 1.07-2.64, p = 0.025), and low body mass index (OR 0.94; 95% CI 0.88-0.99, p = 0.039) were risk factors for developing synchronous ESCC. A low-LMR was significantly associated with decreases in overall survival (p < 0.0001), in both synchronous and non-synchronous groups. Multivariate analysis demonstrated that LMR <4 (HR 1.97; 95% CI 1.38-2.81, p < 0.001), a low-BMI (HR 0.96; 95% CI 0.93-0.99, p = 0.044) and presence of synchronous ESCC (HR 1.56; 95% CI 1.10-2.22, p = 0.013) were independent prognostic factors for HNSCC patients.
Incorporation of LMR into other identified risk factors, such as alcohol consumption, tumor location over pharynx, and low-BMI, may establish a more efficient screening program for esophageal exploration in HNSCC patients. The significances of LMR also suggest that anti-cancer immunity may play a role in the filed cancerization to initiate multiple cancers, and the immunotherapy may have potentials for prevention or as an adjuvant treatment for synchronous SCC in the future.