外周血中性粒细胞与淋巴细胞比值变化对胃癌患者预后的影响

发布时间：2018-11-07 16:28

【摘要】：研究背景胃癌是全球排名第二的癌症相关的死亡原因,尽管近年来其发病率有下降趋势,但每年仍导致750,000人死亡。炎症与胃癌之间有着紧密的联系,深入学习并研究炎症在胃癌中的分子生物学机制,能为胃癌的治疗提供新的策略。目的外周血中性粒细胞与淋巴细胞的比值(NLR)是反应机体炎症的重要血清标志,大量研究成果显示,NLR升高与胃癌患者的低生存率具有相关性。NLR升高提示胃癌患者预后较差。以往研究只关注于胃癌患者接受治疗之前的NLR水平,而对于术后NLR与胃癌患者预后的相关性却鲜有报道。NLR是一个动态变化的过程,术前与术后NLR的变化,从侧面反映出机体内免疫功能的变化。而且目前的临床研究并未就NLR水平高低的临界值达成统一。本文通过回顾性分析275例胃癌患者临床病理特点,探讨NLR变化与胃癌患者预后之间的关系。方法回顾性分析2010年5月至2011年12月间于山东大学齐鲁医院普外科接受治疗的275例胃癌患者,随访记录获得临床病理资料和预后信息。采用IBM SPSS Statistics 软件(version 22.0;SPSS,Inc.,Chicago,IL,USA)行统计学分析。X2检验应用于比较分类变量,独立样本的t检验应用于连续变量的比较。总生存期(OS)和无复发生存期(RFS)用Kaplan-Meier法计算并用log-rank检验法进行分析。采用Kaplan-Meier生存曲线单因素分析患者年龄、性别、肿瘤位置、分化程度、肿瘤直径、阳性淋巴结比例、肿瘤侵袭深度、淋巴结转移数目、有无癌栓、术前CEA、术前CA19-9、术后是否接受化疗与患者RFS及OS的关系。利用COX比例风险回归多因素分析临床病理资料与OS和RFS的关系。P0.05表示差异有统计学意义。结果:共收集275例于齐鲁医院接受手术治疗的胃癌患者的临床资料,其中男性202例,女性73例。根据术前及术后患者NLR比值变化,将其分为两组:NLR升高组,NLR降低组。两组患者年龄、性别、肿瘤位置、分化程度、肿瘤直径、阳性淋巴结比例、肿瘤侵袭深度、淋巴结转移数目、有无癌栓、术前CEA、术前CA19-9、术后是否接受化疗等临床病理资料间差异无统计学意义。对于术后NLR升高的患者,其1、3、5年RFS分别为64.2%,23.2%,15.8%;对于术后NLR降低的患者,其1、3、5年RFS分别为73.9%,49.9%,47.0%。,差异有统计学意义(P0.001)。对于术后NLR升高的患者,其1、3、5年OS分别为81.1%,34.7%,15.8%;对于术后NLR降低的患者,其1、3、5年OS分别为88.3%,57.8%,47.1%,差异有统计学意义(P,0.001)。单因素分析结果显示患者肿瘤直径、淋巴结阳性比率、淋巴结阳性数目、癌栓、术前血清CEA、术前血清CA19-9、术后NLR变化以及术后化疗与胃癌预后相关。多因素分析结果显示,术后NLR变化,肿瘤直径,淋巴结阳性比率,术后化疗是胃癌患者预后的独立影响因素。结论术后NLR变化是影响胃癌患者预后的独立因素。无论术前NLR水平高或低,对于术后NLR升高的患者,其预后要比术后NLR减低的患者更差。
[Abstract]:Background gastric cancer is the world's second leading cause of cancer-related deaths, accounting for 750000 deaths a year, despite a downward trend in recent years. There is a close relationship between inflammation and gastric cancer. Studying and studying the molecular biological mechanism of inflammation in gastric cancer can provide a new strategy for the treatment of gastric cancer. Objective the ratio of peripheral blood neutrophils to lymphocytes (NLR) is an important serum marker of inflammation. The increase of NLR was correlated with the low survival rate of gastric cancer patients, and the increase of NLR suggested that the prognosis of gastric cancer patients was poor. Previous studies only focused on NLR levels in patients with gastric cancer before treatment, but the correlation between postoperative NLR and prognosis of gastric cancer patients was rarely reported. NLR is a dynamic process, and the changes of NLR before and after operation. The changes of immune function in the body are reflected from the side. Moreover, the current clinical studies have not unified the critical value of NLR level. The clinicopathological features of 275 patients with gastric cancer were retrospectively analyzed to explore the relationship between the changes of NLR and the prognosis of gastric cancer patients. Methods 275 patients with gastric cancer received general surgery from May 2010 to December 2011 in Qilu Hospital of Shandong University were retrospectively analyzed. The clinicopathological data and prognostic information were obtained. The statistical analysis was carried out by using IBM SPSS Statistics software (version 22.0 / SPSSc.Chicagoil USA). The X2 test was applied to compare the classified variables, and the t-test of independent samples was applied to the comparison of continuous variables. Total survival time (OS) and recurrence free survival (RFS) were calculated by Kaplan-Meier method and analyzed by log-rank test. Age, sex, tumor location, differentiation degree, tumor diameter, positive lymph node ratio, depth of tumor invasion, number of lymph node metastasis, tumor thrombus, preoperative CA19-9, before CEA, were analyzed by single factor analysis of Kaplan-Meier survival curve. The relationship between chemotherapy and RFS and OS after operation. COX proportional risk regression was used to analyze the relationship between clinicopathological data and OS and RFS. Results: a total of 275 patients with gastric cancer underwent surgical treatment in Qilu Hospital were collected, including 202 males and 73 females. According to the changes of NLR ratio before and after operation, the patients were divided into two groups: NLR increased group and NLR decreased group. Age, sex, tumor location, degree of differentiation, diameter of tumor, proportion of positive lymph nodes, depth of invasion, number of lymph node metastasis, tumor thrombus, preoperative CA19-9, before CEA, There was no significant difference in clinical and pathological data such as chemotherapy after operation. For the patients with elevated NLR after operation, the RFS of 1 and 5 years were 64.2 and 23.2and 15.8respectively. For the patients with lower NLR after operation, the RFS in 1 and 5 years were 73.9 and 47.9, respectively. The difference was statistically significant (P0.001). For the patients with elevated NLR after operation, the OS of 1 and 5 years were 81.1 and 34.7, respectively. For the patients with lower NLR after operation, the OS in 1 and 5 years were 88.3and 57.8, respectively. The difference was statistically significant (P0. 001). Univariate analysis showed that tumor diameter, lymph node positive ratio, number of lymph nodes positive, tumor thrombus, serum CA19-9, before and after operation of CEA, and postoperative chemotherapy were correlated with prognosis of gastric cancer. Multivariate analysis showed that postoperative NLR, tumor diameter, lymph node positive ratio and postoperative chemotherapy were independent prognostic factors in patients with gastric cancer. Conclusion postoperative NLR is an independent factor for the prognosis of gastric cancer patients. Whether the preoperative NLR level was high or low, the prognosis of patients with elevated NLR was worse than that of patients with lower NLR.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.2

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