交通医学

目的：探讨单核细胞/淋巴细胞比值(monocyte to lymphocyte ratio,MLR)、全身免疫炎症指数(systemic immune inflammation index,SII)与口腔鳞状细胞癌(oral squamous cell carcinoma,OSCC)患者临床病理特征及预后的相关性。方法：选取口腔鳞状细胞癌患者93例作为观察组，以同期体检正常的志愿者86例作为对照组。比较两组MLR、SII水平；比较不同病理分级、病理分期、有无淋巴结转移患者MLR、SII水平。93例OSCC患者术后随访期间复发或死亡37例为预后不良组，其余56例为预后良好组，比较两组MLR、SII水平。绘制受试者工作特征(receiver operating characteristic, ROC)曲线，并计算曲线下面积(area under curve,AUC)，分析MLR、SII单独及联合检测对OSCC患者预后不良的预测价值。结果：观察组血液MLR、SII水平为0.690±0.174、(512.4±122.3)×10⁹/L，分别高于对照组的0.509±0.136和(385.5±109.1)×10⁹/L(均P<0.001)。中低分化患者MLR(0.729±0.168 vs 0.635±0.170)、SII[(540.2±119.4)×10⁹/L vs(472.2±116.5)×10⁹/L]水平高于高分化患者；临床分期Ⅲ～Ⅳ期患者MLR(0.789±0.140 vs 0.636±0.168)、SII[(588.0±108.7)×10⁹/L vs(470.9±109.4)×10⁹/L]水平高于临床分期Ⅰ～Ⅱ期患者；淋巴结转移的口腔癌患者MLR(0.754±0.163 vs 0.659±0.171)、SII[(561.3±115.9)×10⁹/L vs(485.6±118.2)×10⁹/L]水平高于无淋巴结转移患者(均P<0.01)。预后不良组MLR、SII水平为0.731±0.173、(542.1±125.3)×10⁹/L，分别高于预后良好组的0.663±0.171、(491.9±117.0)×10⁹/L(均P<0.001)。ROC曲线分析显示，MLR、SII单独预测OSCC患者预后不良的AUC分别为0.765、0.751，低于MLR、SII联合预测的AUC 0.783(均P<0.001)。结论：口腔鳞状细胞癌患者MLR、SII水平异常升高，与肿瘤恶性程度及不良预后密切相关，MLR与SII联合检测可显著提升OSCC患者预后评估的准确性。

Objective: To explore the relationship between the monocyte to lymphocyte ratio(MLR), systemic immune inflammation index(SII) and the clinical pathological characteristics, and the prognosis of patients with oral squamous cell carcinoma(OSCC). Methods: Select 93 OSCC patients as the observation group, and 86 volunteers with normal physical examination findings at the same time as the healthy control group. Compare the levels of MLR and SII in blood samples between the two groups. During the postoperative follow-up period, 37 OSCC patients experienced recurrence or death, which were classified as the poor prognosis group, while the remaining 56 patients were classified as the good prognosis group. The levels of blood MLR and SII were compared between the two groups of patients. The receiver operating characteristic(ROC) curves were plotted to determine area under curve(AUC), and the predictive value of the individual and combined detection of blood MLR and SII indicators for the poor prognosis of OSCC patients was analyzed. Results:The levels of blood MLR and SII in the observation group were 0.690±0.174 and(512.4±122.3)×10⁹/L respectively, which were higher than 0.509±0.136 and(385.5±109.1)×10⁹/L in the control group(P<0.001). The MLR and SII levels in patients with moderate to low differentiation were 0.729±0.168 and(540.2±119.4)×10⁹/L, which were higher than 0.635±0.170 and(472.2 ±116.5) ×10⁹/L in patients with high differentiation; the MLR and SII levels in patients with clinical stage III ～IV were 0.789±0.140 and(588.0±108.7)×10⁹/L, which were higher than 0.636±0.168 and(470.9±109.4)×10⁹/L in patients with clinical stage I～II; the MLR and SII levels in patients with lymph node metastasis were 0.754±0.163 and(561.3±115.9)×10⁹/L, which were higher than 0.659±0.171 and(485.6±118.2)×10⁹/L in patients without lymph node metastasis. The levels of MLR and SII in the poor prognosis group were 0.731±0.173 and(542.1±125.3)×10⁹/L respectively, which were higher than 0.663±0.171 and(491.9±117.0)×10⁹/L in the good prognosis group(P<0.001). The ROC curve analysis showed that AUC values for predicting poor prognosis of OSCC patients by blood MLR and SII alone were 0.765 and 0.751 respectively,which were lower than AUC value of 0.783 by the combined detection of MLR and SII(P<0.001). Conclusion: The levels of MLR and SII in patients with oral squamous cell carcinoma are abnormally elevated, and they are closely related to the malignancy of the tumor and poor prognosis. The combined detection of MLR and SII can significantly improve the accuracy of prognosis assessment for OSCC patients.