摘要
目的探讨老年胃癌患者术前外周血中性粒细胞与淋巴细胞比值（NLR）的临床意义及NLR与患者预后的关系。方法回顾性分析2007年1月到2010年12月间在哈尔滨医科大学附属肿瘤医院胃肠外科行手术治疗的160例年龄≥75岁的胃癌患者临床资料。收集患者术前血常规中性粒细胞和淋巴细胞计数以计算NLR。通过受试者工作特征曲线确定NLR预测患者总体生存期的截点值，并根据该截点值将患者分为两组。比较两组患者临床病理特征；绘制Kaplan—Meier曲线进行生存分析，采用Cox回归模型进行多因素预后分析。结果NLR预测患者术后总生存期的截点值为1．83，其对应的敏感性和特异性分别为0．709和0．562。NLR〈1．83者为NLR-0组（54例），NLR≥1．83者为NLR-1组（106例）。NLR-1组与NLR-0组患者相比，肿瘤直径≥50mm[66．0％（70／106）比42．6％（23／54），P=0．004]、肿瘤侵出浆膜[75．5％（80／106）比57．4％（31／54），P=0．029]、淋巴结转移阳性[83．0％（88／106）比55．6％（30／54），P=0．001]和Ⅲ期患者[79．2％（84／106）比61．1％（33／54），P=0．013]所占比例明显增高。NLR-0组和NLR．1组中位生存时间分别为1209d和587d，差异有统计学意义（P=0．001）。多因素预后分析结果显示，NLR≥1．83（HR=1．800，95％口：1．039～3．116，P=0．036）、肿瘤侵出浆膜（HR=1．967，95％Ci1．082～3．573，P：0．026）及淋巴结转移（HR=5．263，95％CI：2．078～13．328，P=0．001）是影响老年胃癌患者生存期的独立危险因素。结论老年胃癌患者术前NLR升高提示患者病灶较大，肿瘤侵出浆膜及淋巴结转移的概率更高，临床分期更晚，预后较差。
Objective To investigate the clinical implication of preoperative neutrophil-to- lymphocyte ratio （NLR）, and association of NLR with the prognosis of the elderly patients over 75 years old with primary gastric cancer. Methods Clinical data of 160 patients （≥75 years） with gastric cancer undergoing gastrectomy in Department of Gastrointestinal Surgery, the Tumour Hsopital of Harbin Medical University form January 2007 to December 2010 were retrospectively analyzed. Preoperative neutrophil and lymphocyte count was measured and NLR was calculated. The cut-off value of NLR to predict the survival was obtained from the receiver operating characteristic （ROC） curve. Patients were divided into two groups based on cut-off value. Clinicopathological features were compared between two groups using Chi-square test or Fisher exact test. Cox proportional hazard model was used to analyze risk factors associated with survival. Results The cut-off value of NLR was 1.83 with 0.709 of sensitivity and 0.562 of specificity. A total of 54 patients with NLR〈1.83 belonged to NLR-0 group, and 106 patients with NLR≥1.83 belonged to NLR-1 group. As compared to NLR-0 group, patients in NLR-1 group had significantly higher proportion in maximum tumor size≥50 mm [66.0%（70/106） vs. 42.6%（23/54）, P= 0.004], serosal invasion [75.5%（80/106） vs. 57.4%（31/54）, P= 0.029%, positive lymph node metastasis E83.0% （88/106） vs. 55.6%（30/54）, P = 0.001] and TNM stage m [79.2%（84/106） vs. 61.1%（33/54）, P= 0.013]. The median survival of NLR-0 and NLR-1 group was 1 209 days and 587 days respectively, with significant difference （P = 0.001）. Multivariate analysis showed that NLR≥1.83 （HR = 0.530, 95% CI： 0.332 to 0.846, P= 0.008）, serosal invasion （HR = 0.570, 95% CI： 0.332 to 0.979, P= 0.042）, and lymph node metastasis（HR = 0.475, 95% CI： 0.462 to 1.685, P= 0.033） were independent risk factors of poor prognosis （all P 〈 0.05）. Conclusion Preoperative higher NLR value in the elderly patients over 75 years old with primary gastric cancer indicates larger tumor size, severe serous invasion, more lymph node metastasis, later TNM staging, and poorer prognosis.
出处
《中华胃肠外科杂志》
CAS
CSCD
北大核心
2016年第5期526-529,共4页
Chinese Journal of Gastrointestinal Surgery
