[Study on the prognostic influencing factors of esophageal squamous cell carcinoma and the predictive value of inflammatory reaction indexes on its postoperative recurrence].

Objective: To explore the influence factors of poor prognosis of esophageal squamous cell carcinoma (ESCC) and the predictive value of inflammatory reaction indexes including neutrophils and lymphocytes ratio (NLR), platelet and lymphocyte ratio (PLR), monocyte and lymphocyte ratio (MLR) provision and differentiation degree, infiltration depth, lymph node metastasis number on the postoperative recurrence of ESCC. Methods: A total of 130 patients with ESCC who underwent radical resection from February 2017 to February 2019 in Nanyang Central Hospital were selected and divided into good prognosis group (66 cases) and poor prognosis group (64 cases) according to the prognostic effect. The clinical data and follow-up data were collected. Multivariate logistic regression analysis was used to determine the independent influencing factors of poor prognosis. Spearman correlation analysis was used to determine the correlation between preoperative NLR, PLR and MLR with the degree of differentiation, depth of invasion and number of lymph node metastases. Receiver operating characteristic (ROC) curve analysis was used to evaluate the efficacy of NLR, PLR and MLR in predicting poor prognosis of ESCC. Results: Univariate analysis showed that the degree of differentiation, the degree of invasion and the number of lymph node metastasis were related to the prognoses of patients with ESCC (P<0.05). Multivariate logistic regression analysis showed that the degree of differentiation, depth of invasion and number of lymph node metastases were independent influencing factors for poor prognosis of patients with ESCC, moderate differentiation (OR=2.603, 95% CI: 1.009-6.715) or low differentiation (OR=9.909, 95% CI: 3.097-31.706), infiltrating into fibrous membrane (OR=14.331, 95% CI: 1.333-154.104) or surrounding tissue (OR=23.368, 95% CI: 1.466-372.578), the number of lymph node metastases ≥ 3 (OR=9.225, 95% CI: 1.693-50.263) indicated poor prognosis. Spearman correlation analysis showed that NLR was negatively correlated with the degree of differentiation and the number of lymph node metastases (r=-0.281, P=0.001; r=-0.257, P=0.003), PLR was negatively correlated with the degree of differentiation, depth of invasion and number of lymph node metastasis (r=-0.250, P=0.004; r=0.197, P=0.025; r=-0.194, P=0.027), MLR was positively correlated with the degree of differentiation and the number of lymph node metastasis (r=0.248, P=0.004; r=0.196, P=0.025). ROC curve analysis showed that the areas under the curve of NLR, PLR and MLR in predicting poor prognosis of ESCC were 0.971, 0.925 and 0.834, respectively. The best cut-off value of NLR was 2.87. The sensitivity and specificity of NLR in predicting poor prognosis of ESCC were 90.6% and 87.9%, respectively. The optimal cut-off value of PLR was 141.75. The sensitivity and specificity for predicting poor prognosis of ESCC were 92.2% and 87.9%, respectively. The best cut-off value of MLR was 0.40. The sensitivity and specificity of MLR in predicting poor prognosis of esophageal squamous cell carcinoma were 54.7% and 100.0%, respectively. Conclusions: The degree of differentiation, the degree of invasion and the number of lymph node metastases are closely related to the poor prognosis of patients with esophageal squamous cell carcinoma. NLR, PLR and MLR can provide important information for predicting the poor prognosis of esophageal squamous cell carcinoma.目的： 探讨食管鳞状细胞癌预后不良的影响因素及中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)、单核细胞与淋巴细胞比值(MLR)与分化程度、浸润深度、淋巴结转移数目等炎性反应指标对食管鳞状细胞癌术后复发的预测价值。 方法： 选取2017年2月至2019年2月在南阳市中心医院行根治术治疗的130例食管鳞状细胞癌患者，按照预后效果分为预后良好组(66例)和预后不良组(64例)。收集其临床资料和随访资料。采用多因素logistic回归分析确定患者预后不良的独立影响因素，采用Spearman相关分析明确术前NLR、PLR和MLR与分化程度、浸润深度、淋巴结转移数目的相关性，采用受试者工作特征(ROC)曲线分析评价NLR、PLR和MLR预测食管鳞状细胞癌预后不良的效能。 结果： 单因素分析显示，分化程度、浸润程度、淋巴结转移数目与食管鳞状细胞癌患者的预后有关(均P<0.05)。多因素logistic回归分析显示，分化程度、浸润深度和淋巴结转移数目均为食管鳞状细胞癌患者预后不良的独立影响因素，中分化(OR＝2.603，95% CI：1.009~6.715)或低分化(OR＝9.909，95% CI：3.097~31.706)、浸润到纤维膜(OR＝14.331，95% CI：1.333~154.104)或周围组织(OR＝23.368，95% CI：1.466~372.578)、淋巴结转移数目≥3枚(OR＝9.225，95% CI：1.693~50.263)的患者患者预后不良。Spearman相关分析显示，NLR与分化程度、淋巴结转移数目呈负相关(r＝－0.281，P＝0.001；r＝－0.257，P＝0.003)，PLR与分化程度、浸润深度、淋巴结转移数目呈负相关(r＝－0.250，P＝0.004；r＝－0.197，P＝0.025；r＝－0.194，P＝0.027)，MLR与分化程度、淋巴结转移数目呈正相关(r＝0.248，P＝0.004；r＝0.196，P＝0.025)。ROC曲线分析显示，NLR、PLR和MLR预测食管鳞状细胞癌预后不良的曲线下面积分别为0.971、0.925和0.834。NLR的最佳界值为2.87，预测食管鳞状细胞癌预后不良的灵敏度为90.6%，特异度为87.9%。PLR的最佳界值为141.75，预测食管鳞状细胞癌预后不良的灵敏度为92.2%，特异度为87.9%。MLR的最佳界值为0.40，预测食管鳞状细胞癌预后不良的灵敏度为54.7%，特异度为100.0%。 结论： 分化程度、浸润程度、淋巴结转移数目与食管鳞状细胞癌预后不良密切相关，NLR、PLR和MLR能为食管鳞状细胞癌预后不良预测提供重要信息。.