放疗前肿瘤最大径、外周血NLR对食管鳞状细胞癌患者放疗后发生食管瘘的预测价值

摘要/Abstract

摘要：

目的探讨放疗前肿瘤最大径、外周血中性粒细胞与淋巴细胞比值（NLR）对食管鳞状细胞癌患者放疗后发生食管瘘的预测价值。方法选取2017年2月—2021年2月在中国科学院合肥肿瘤医院行放疗的食管鳞状细胞癌患者98例，根据随访过程中是否发生食管瘘将患者分为食管瘘组（13例）和无食管瘘组（85例）。计算放疗前预后营养指数（PNI）、NLR、全身炎症反应指数（SIRI）值。采用单因素和多因素logistic回归分析患者发生食管瘘的影响因素，采用受试者操作特征（ROC）曲线评估各项指标的预测价值。结果食管瘘组与无食管瘘组患者年龄、吸烟史、糖尿病病史、性别、是否同步化疗、饮酒史差异均无统计学意义（均P>0.05），PNI（t=2.24，P=0.041）、NLR（t=3.75，P=0.001）、SIRI（t=2.68，P=0.015）差异均有统计学意义。单因素分析显示，肿瘤长度（OR=1.16，95%CI为1.01~1.35，P=0.043）、肿瘤最大径（OR=1.63，95%CI为1.11~2.39，P=0.012）、PNI（OR=0.83，95%CI为0.71~0.98，P=0.023）、NLR（OR=1.94，95%CI为1.20~3.12，P=0.007）、SIRI（OR=1.82，95%CI为1.03~3.24，P=0.041）均与食管瘘发生有关。多因素分析显示，肿瘤最大径（OR=2.17，95%CI为1.02~4.94，P=0.033）和NLR（OR=2.40，95%CI为1.89~6.59，P=0.018）均是影响食管鳞状细胞癌患者放疗后发生食管瘘的独立影响因素。ROC曲线分析显示，放疗前肿瘤最大径联合NLR预测食管鳞状细胞癌患者放疗后发生食管瘘的曲线下面积为0.83（95%CI为0.74~0.90），大于放疗前肿瘤最大径及NLR分别预测的0.71（95%CI为0.63~0.81，Z=1.80，P=0.039）、0.74（95%CI为0.67~0.85，Z=1.64，P=0.046）。结论放疗前肿瘤最大径和NLR与食管鳞状细胞癌患者放疗后食管瘘的发生密切相关，有望作为预测食管鳞状细胞癌患者放疗后发生食管瘘的重要预测指标。

关键词:食道鳞癌,放射疗法,食管瘘,肿瘤最大径,中性粒细胞与淋巴细胞比值

Abstract:

ObjectiveTo investigate the predictive value of maximum tumor diameter and the peripheral blood neutrophil to lymphocyte ratio （NLR） before radiotherapy for the occurrence of esophageal fistula after radiotherapy in patients with esophageal squamous cell carcinoma （ESCC）.MethodsA total of 98 patients with ESCC who underwent radiotherapy in Hefei Cancer Hospital， Chinese Academy of Sciences from February 2017 to February 2021 were selected， and the patients were divided into esophageal fistula group （13 cases） and no esophageal fistula group （85 cases） according to whether esophageal fistula occurred during the follow-up process. The prognostic nutritional index （PNI）， NLR， and systemic inflammatory response index （SIRI） were calculated. Univariate and multivariate logistic regression were used to analyze the influencing factors of esophageal fistula， and the predictive value of each indicator was evaluated by using the receiver operator characteristic （ROC） curve.ResultsThere were no statistically significant differences in age， smoking history， diabetes mellitus history， gender， concurrent chemotherapy and alcohol history between the esophageal fistula group and the no esophageal fistula group （allP>0.05）， while there were statistically significant differences in PNI （t=2.24，P=0.041）， NLR （t=3.75，P=0.001）， SIRI （t=2.68，P=0.015）. Univariate analysis showed that tumor length （OR=1.16， 95%CI： 1.01-1.35，P=0.043）， maximum tumor diameter （OR=1.63， 95%CI： 1.11-2.39，P=0.012）， PNI （OR=0.83， 95%CI： 0.71-0.98，P=0.023）， NLR （OR=1.94， 95%CI： 1.20-3.12，P=0.007） and SIRI （OR=1.82， 95%CI： 1.03-3.24，P=0.041） were related to esophageal fistula. Multivariate analysis showed that maximum tumor diameter （OR=2.17， 95%CI： 1.02-4.94，P=0.033） and NLR （OR=2.40， 95%CI： 1.89-6.59，P=0.018） were independent influencing factors for the development of esophageal fistula in patients with ESCC after radiotherapy. ROC curve analysis showed that the area under the curve of maximum tumor diameter before radiotherapy combined with NLR for predicting esophageal fistula in patients with esophageal squamous cell carcinoma after radiotherapy was 0.83 （95%CI： 0.74-0.90）， which was greater than that of maximum tumor diameter before radiotherapy （0.71， 95%CI： 0.63-0.81，Z=1.80，P=0.039） and NLR （0.74， 95%CI： 0.67-0.85，Z=1.64，P=0.046） alone.ConclusionsThe maximum tumor diameter before radiotherapy and NLR are closely related to the occurrence of esophageal fistula in ESCC after radiotherapy， and these factors are expected to serve as key predictors of the occurrence of esophageal fistula.

Key words:Esophageal squamous cell carcinoma,Radiotherapy,Esophageal fistula,Maximum tumor diameter,Neutrophil to lymphocyte ratio

吴晓维, 胡格, 陈莉, 钱晓涛, 崔相利, 朱凤琴. 放疗前肿瘤最大径、外周血NLR对食管鳞状细胞癌患者放疗后发生食管瘘的预测价值[J]. 国际肿瘤学杂志, 2025, 52(1): 38-42.

Wu Xiaowei, Hu Ge, Chen Li, Qian Xiaotao, Cui Xiangli, Zhu Fengqin. Predictive value of pre-radiotherapy maximum tumor diameter and peripheral blood NLR for esophageal fistula in esophageal squamous carcinoma patients[J]. Journal of International Oncology, 2025, 52(1): 38-42.

图/表4

表1

两组行根治性放疗食管鳞状细胞癌患者一般临床资料比较（例/ $\bar{x}±s$）"

一般临床特征	食管瘘组（n=13）	无食管瘘组（n=85）	χ²/t值	P值
年龄（岁）
≥60	9	75	3.33	0.068
<60	4	10	3.33	0.068
吸烟史
有	5	39	0.26	0.616
无	8	46	0.26	0.616
糖尿病病史
有	0	2		0.751
无	13	83		0.751
性别
男	13	62	3.21	0.073
女	0	23	3.21	0.073
同步化疗
是	4	35	0.17	0.682
否	9	50	0.17	0.682
饮酒史
有	4	32	0.03	0.865
无	9	53	0.03	0.865
PNI	43.57±5.69	46.57±7.34	2.24	0.041
NLR	3.65±0.94	2.54±1.29	3.75	0.001
SIRI	1.86±0.70	1.29±0.89	2.68	0.015

表1

表2

影响98例食管鳞状细胞癌患者根治性放疗后食管瘘发生的单因素分析"

变量	OR值	95%CI	P值
肿瘤类型（溃疡型/非溃疡型）	1.03	0.42~2.52	0.943
肿瘤部位
颈段	Ref
胸上段	0.73	0.12~4.59	0.740
胸中段	1.08	0.17~6.65	0.940
胸下段	1.28	0.19~8.66	0.800
处方总放疗剂量（≥60 Gy/<60 Gy）	0.90	0.80~1.02	0.102
放疗前鼻饲（是/否）	1.01	0.20~5.08	0.993
同步化疗（是/否）	0.64	0.18~2.23	0.478
肿瘤长度	1.16	1.01~1.35	0.043
肿瘤最大径	1.63	1.11~2.39	0.012
PNI	0.83	0.71~0.98	0.023
NLR	1.94	1.20~3.12	0.007
SIRI	1.82	1.03~3.24	0.041

表2

变量	OR值	95%CI	P值
肿瘤长度	0.94	0.56~1.50	0.351
肿瘤最大径	2.17	1.02~4.94	0.033
PNI	1.47	0.15~2.83	0.151
NLR	2.40	1.89~6.59	0.018
SIRI	0.01	0.00~1.18	0.997

表3

图1

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