Abstract：Objective To explore whether neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) or β-human chronic gonadotropin (β-hCG) along or in combination can predict the risk of malignant transformation from hydatidiform mole to gestational trophoblastic neoplasm (GTN). Methods This study recruited hydatidiform mole patients who attended the gynecology departments of the affiliated Hospital of Qinghai University and Qinghai Red Cross Hospital, from January 2015 to December 2017. Those patients were given standardized diagnosis and treatment throughout the study period, and visited regularly. A total of 175 patients with hydatidiform mole were finally enrolled in this study. According to β-hCG levels measured 2 years after curettage, those patients were divided into a malignant group (n=38) and a cured group (n=137). The blood routine testing results on neutrophil (N), lymphocyte (L), and platelet count (PLT) were collected before and after uterine curettage. The neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio were further derived. We evaluated how those clinical markers could predict the malignant transformation using the area under the curve (AUC) statistic derived from the receiver operating characteristic (ROC) curves. Results For N, NLR, PLR or lgβ-hCG measured before the first curettage, the mean value in the malignant group was significantly higher than that in the cured group (P＜0.05). Mean L value in the cured group was significantly higher than that in the malignant group (P＜0.05). Among the clinical markers measured before first curettage, for NLR=3.23, PLR=159.38, or their combination, the AUC was estimated as 0.727 (P＜0.05, 95%CI:0.63-0.82), 0.675 (P＜0.05, 95%CI:0.58-0.78), or 0.724 (P＜0.05,95%CI:0.65～0.79), respectively; Among the markers measured after curettage, PLR=129.2, the AUC was 0.636 (P＜0.05, 95%CI:0.56-0.71). Conclusion Among hydatidiform mole patients, the risk of malignant transformation can be predicted by NLR and PLR before the first curettage, or PLR after curettage.
雷欣蓉, 陈晓琦, 杨勇莉, 秦阿妮. 中性粒细胞/淋巴细胞比值及血小板/淋巴细胞比值在预测葡萄胎恶变中的价值[J]. 中国生育健康杂志, 2022, 33(4): 342-346.
LEI Xinrong, CHEN Xiaoqi, YANG Yongli, QIN Ani. Predicting malignant transformation of hydatidiform mole by neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio. Chinese Journal of Reproductive Health, 2022, 33(4): 342-346.
1 向阳,尹如铁.妊娠滋养细胞疾病诊断与治疗指南(2021年版).中国癌症杂志,2021,31:520-532. 2 Guzel AI,Kokanali MK,Erkilinc S,et al.Predictive role of the neutrophil lymphocyte ratio for invasion with gestational trophoblastic disease.Asian Pac J Cancer Prev,2014,15:4203-4206. 3 Ngan HYS,Seckl MJ,Berkowitz RS.Update on the diagnosis and management of gestational trophoblastic disease.Gynecol Oncol,2018,143:79-85. 4 王丽娟,林海雪,林仲秋.《2022 NCCN妊娠滋养细胞肿瘤临床实践指南(第1版)》解读.中国实用妇科与产科杂志,2022,38:78-84. 5 Seckl MJ,Sebire NJ,Berkowitz RS.Gestational trophoblastic disease Lancet,2010,376:717-729. 6 格日力,主编.高原医学.第1版.北京:北京大学医学出版社,2014:1-312. 7 Yoon NB,Son C,Um SJ.Role of the neutrophil-lymphocyte count ratio in the differential diagnosis between pulmonary tuberculosis and bacterial community-acquired pneumonia.Ann Lab Med,2013,33:105-110. 8 Wang Q,Liu F,Zhao Y,et al.Can neutrophil-to-lymphocyte and monocyte-to-lymphocyte ratios be useful markers for predicting missed abortion in the first trimester of pregnancy?.J Obstet Gynaecol Res,2020,46:1702-1710. 9 刘睿,张涛红,胡娇娇,等.外周血系统性炎症标志物预测完全性葡萄胎恶变的价值研究.实用妇产科杂志,2020,36:31-36. 10 Tas M,Yavuz A,Ak M,et al.Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in discriminating precancerous pathologies from cervical cancer.J Oncol,2019,2019:1-6. 11 Lochowski M,Lochowska B,Zawadzka I,et al.Prognostic value of neutrophil-to-lymphocyte,platelet-to-lymphocyte and lymphocyte-to-monocyte ratio ratios in patients operated on due to non-small cell lung cancer.J Thorac Dis,2019,11:3377-3384. 12 Zhu ML,Feng M,He F,et al.Pretreatment neutrophil-lymphocyte and platelet-lymphocyte ratio predict clinical outcome and prognosis for cervical Cancer.Clin Chim Acta,2018,483:296-302. 13 Hu C,Bai Y,Li J,et al.Prognostic value of systemic inflammatory factors NLR,LMR,PLR and LDH in penile cancer.BMC Urology,2020,20:57. 14 Yin X,Wu L,Yang H,et al.Prognostic significance of neutrophil-lymphocyte ratio (NLR) in patients with ovarian cancer:A systematic review and meta-analysis.Medicine,2019,98:e17475. 15 Hotchkiss RS,Karl IE.The pathophysiology and treatment of sepsis.N Engl J Med,2003,348:138-150. 16 Movahedi K,Guilliams M,Bossche JVD,et al.Identification of discrete tumor-induced myeloid-derived suppressor cell subpopulations with distinct T cell-suppressive activity.Blood,2008,111:4233-4244. 17 Scapini P,Morini M,Tecchio C,et al.CXCL1/macrophage inflammatory protein-2-induced angiogenesis in vivo is mediated by neutrophil-derived vascular endothelial growth factor-A.J Immunol,2004,172:5034-5040. 18 陈雨薇,张虹.清宫前中性粒细胞-淋巴细胞比值对葡萄胎恶变的预测价值.实用妇产科杂志,2016,32:294-297.
