目的：探讨肺肉瘤样癌（pulmonary sarcomatoid carcinoma，PSC）患者外周血中单核细胞与淋巴细胞的比值（monocyte-to-lymphocyte ratio，MLR）与患者临床病理特征和预后的关系及其临床意义。方法：回顾性分析2010 年10 月至2017 年4 月天津市肿瘤医院80 例PSC患者的完整病例资料，采用受试者工作曲线（ROC）确定MLR预测OS的最佳临界值，将患者分为高和低MLR组，用Kaplan-Meier 方法计算得到OS并绘制生存曲线，Log-Rank 检验用于比较两组间OS的差别；将单因素有意义的变量带入COX风险回归模型验证、计算风险比（HR)及95%可信区间(95%CI)。结果：单核细胞、淋巴细胞中位绝对值分别为0.63×109/L、1.84×109/L，MLR最佳截点值为0.44。单因素分析显示，MLR≥0.44（P<0.01）、未行根治性手术（P<0.01）、临床分期Ⅲ+Ⅳ期（P<0.01）、肿瘤最大径>3 cm（P<0.05）、LDH>247 U/L（P<0.01）是影响OS 的不良预后因素。多因素分析显示，MLR≥0.44（HR=3.554；95%CI=1.671~6.125；P<0.01）、临床分期Ⅲ+Ⅳ期（HR=3.275；95%CI=2.047~9.399；P<0.01）是影响PSC患者OS的独立危险因素，根治性手术是影响PSC 患者OS的独立保护性因素（HR=0.360；95%CI=0.195~0.848；P<0.01）。结论：高MLR是PSC 患者不良预后的独立危险因素。

Objective: To explore the relationship between monocyte-to-lymphocyte ratio (MLR) in peripheral blood of patients with pulmonary sarcomatoid carcinoma (PSC) and their clinicopathological features and prognosis, and to investigate its clinical significance.Methods: A retrospective analysis was carried out to analyze the complete case data of 80 patients with PSC from October 2010 to April 2017 in Tianjin Cancer Hospital (monocyte and lymphocyte counts of peripheral blood, clinicopathological features, and survival follow-up). The receiver operating curve (ROC) was used to determine the best cut-off value of MLR for the prediction of overall survival time (OS). The patients were divided into high MLR group and low MLR group. Kaplan-Meier method was used to calculate OS and draw survival curves. The Log-Rank test was used to compare the difference in OS between the two groups. The variables with statistical significance in univariate analysis were included into the COX risk regression model to verify and calculate thehazard ratio (HR)and 95% confidence interval (95%CI). Results: The absolute median values of monocytes and lymphocytes were 0.63×109 /L and 1.84×109/L, respectively. The best cut-off value of MLR is 0.44. Univariate analysis shows that MLR≥0.44 (P<0.01), no radical surgery (P<0.01), clinical stage Ⅲ+Ⅳ (P<0.01), tumor maximal diameter > 3 cm (P<0.01), and LDH>247 U /L (P<0.01) are the poor prognostic factors affecting overall survival. Multivariate analysis shows that MLR≥0.44（HR=3.554; 95%CI=1.671-6.125; P<0.01),and clinical stage Ⅲ+Ⅳ（HR=3.275; 95%CI=2.047-9.399; P<0.01) are the independent risk factors for the overall survival of PSC, and radical surgery is an independent protective factor affecting the overall survival of PSC（HR=0.360; 95%CI=0.195-0.848; P<0.01). Conclusion:High MLR is an independent risk factor for poor prognosis in patients with PSC.

国家科技支撑计划资助项目（No.2015BAI12B12）；国家自然科学基金资助项目（No.81272221）