摘要
目的评价术前中性粒细胞/淋巴细胞比值(NLR)与纤维蛋白原(FIB)含量对胃肠道间质瘤(GIST)术后局部复发和(或)远处转移以及5年无复发生存率(RFS)的影响。方法 2010年1月~2015年12月收治的GIST病人170例,术前均未行靶向治疗并接受根治性切除术,回顾性分析术前NLR、FIB与GIST术后远期预后的关系。采用SPSS 18.0进行ROC曲线分析、χ~2检验、非参数秩和检验,相关性分析采用Pearson相关检验,远期生存采用Kaplan-Meier生存分析,多因素分析采用Cox比例风险模型。结果共纳入GIST病人170例,随访期间有24例出现转移复发,复发死亡15例。建立诊断GIST的ROC曲线,NLR与FIB的ROC曲线下面积分别为0.608、0.758;当取NLR=1.864、FIB=3.24 g/L为分界点时,NLR、FIB诊断GIST的敏感性和特异性最高。NLR、FIB均与GIST病人的年龄、性别、肿瘤部位、大小、危险度分级间存在相关关系,且NLR与FIB之间也存在相关性。本组病人术后5年RFS为75%。NLR<1.864组及≥1.864组5年RFS分别为90%和62%(P=0.018);FIB<3.24 g/L组及≥3.24 g/L组5年RFS分别为95%和50%(P<0.01);联合FIB与NLR并将其分为4组:组1 FIB<3.24 g/L与NLR<1.864、组2 FIB≥3.24 g/L与NLR<1.864、组3 FIB≥3.24 g/L与NLR≥1.864、组4 FIB<3.24 g/L与NLR≥1.864,4组5年RFS率分别为100%、78%、38%和92%(P<0.01)。多因素分析显示,FIB(P<0.01,HR=0.098,95%CI:0.029~0.333)、NIH危险度分级(P=0.001,HR=0.128,95%CI:0.037~0.443)是影响GIST术后预后的独立危险因素。结论 NLR与FIB联合检测可预测GIST病人的术后预后。
Objective To evaluate the effects of biomarkers,including neutrophil-to-lymphocyte ratio(NLR)and fibrinogen content(FIB)to local recurrence and/or distant metastasis and 5-year recur-rence free survival(RFS)in patients with gastrointestinal stromal tumor(GIST)after radical surgery.Methods 170 patients with GIST who was from January of 2010 to December of 2015 in the First Affilia-ted Hospital of Xi'an Jiaotong University after radical surgery without neoadjuvant therapy(imatinib)were retrospectively analyzed.The biomarkers included NLR and FIB.SPSS 18 was used for ROC analysis,chi square test,and Mann-Whitney U test,correlation analysis was performed with the Pearson correlation test.The long-term survival was analyzed by Kaplan-Meier survival analysis.Multivariate factors for surviv-al were analyzed by Cox proportional hazards regression model.Results 170 patients were included in this study.During follow-up,24 patients showed recurrence or metastasis,15 patients suffered from GIST related deaths,1 patient was due to the death of car accidents.Establishment of Roc Curve for diagnosis of GIST,the area under the ROC curve of NLR and FIB was 0.608,0.758,respectively.When NLR=1.864,FIB=3.24 g/L was taken as the dividing point respectively,NLR and FIB had the highest sensi-tivity and specificity in the diagnosis of GIST.There was a correlation between NLR,FIB and age,sex,tumor location,size and risk grade of GIST patients,and there was also a correlation between NLR and FIB.The RFS of 5 years after the operation was 75%in the present study.5 years RFS rate of NLR<1.864 group and greater in the NLR group were 90%and 62%,respectively(P=0.018),FIB<3.24 g/L and greater in the FIB group were 95%and 50%,respectively(P<0.01);FIB and NLR were jointed and divided into 4 groups-Group 1:FIB<3.24 g/L and NLR<1.864,Group 2:FIB≥3.24 g/L and NLR<1.864,Group 3:FIB≥3.24 g/L and NLR≥1.864,Group 4:FIB<3.24 g/L and NLR≥1.864,and 5 year RFS rate of 4 group were 100%,78%,38%and 92%,respectively(P<0.01).Multivariate analysis showed that FIB(P<0.01,HR=0.108,95%CI:0.029-0.333)and NIH risk classification(P=0.001,HR=0.128,95%CI:0.037-0.443)was an independent risk factor affecting the prognosis of GIST.Con-clusion The combination of NLR and FIB can effectively predict the postoperative prognosis of GIST pa-tients,but this conclusion needs further study and confirmation.
作者
蔡华霞
王曙逢
CAI Huaxia;WANG Shufeng(Department of Chest Surgery,the Eastern Hospital of the First Affiliated Hospital of Xi'an Jiao-tong University,Shanxi,Xi'an 710089,China)
出处
《临床外科杂志》
2020年第5期452-455,共4页
Journal of Clinical Surgery
