治疗前PLR对以吉西他滨为基础方案化疗的晚期胰腺癌患者的预后预测作用

发布时间：2018-02-10 07:28

本文关键词： 胰腺癌吉西他滨 PLR NLR 预后因素　出处：《山东大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:多项研究表明,肿瘤微环境中的炎症反应在肿瘤的发生与进展过程中发挥不可忽视的作用,全身炎症反应标记物对多种肿瘤的预后具有预测作用。目前研究较多的炎症反应标记物有外周血粒淋比(NLR),外周血血小板与淋巴细胞比值(PLR),外周血淋巴细胞与单核细胞比值(LMR)及预后营养指数(PNI)等。然而目前尚未有研究报道炎症反应标记物对于以吉西他滨为基础方案化疗的晚期胰腺癌病人的预后预测作用。本研究的目的即为探究治疗前炎症反应标记物对以吉西他滨为基础方案化疗的晚期胰腺癌病人的预后预测作用。方法:将2008年1月至2015年7月山东大学齐鲁医院收治的以吉西他滨为基础方案化疗的晚期胰腺癌患者53例纳入研究,搜集患者临床病例资料,并进行回顾性分析。临床病例资料包括患者的临床特征及化疗前各项血液学指标。临床特征包括患者性别,确诊时年龄,吸烟史,嗜酒史,心血管疾病史,糖尿病史。血液学指标包括淋巴细胞绝对值,中性粒细胞绝对值,单核细胞绝对值,血小板绝对值、白蛋白值、CEA值、CA-199值,通过计算得到NLR,PLR,LMR及PNI。利用 ROC 曲线确定 NLR、PLR、LMR、PNI 界值,分别为:3.675,176.62,2.815 和42.11。所有患者随访时间截止于2016年7月。使用Kaplan-Meier生存分析绘制生存曲线,采用log-rank检验比较生存率,利用Cox比例风险回归模型评估预后影响因素的风险比(HR)。结果:纳入研究的53例患者的中位年龄为60岁,平均年龄(58.75±11.42)岁,其中男性患者32人,女性患者21人。中位生存时间为192天,所有患者的临床分期均为Ⅳ期。53人均以吉西他滨为基础方案化疗,其中12人为吉西他滨单药方案化疗,26人为吉西他滨联合氟尿嘧啶类药物方案化疗,15人为吉西他滨联合铂类药物方案化疗。53例患者中有16人有吸烟史,11人有嗜酒史,8人有糖尿病病史,4人有冠心病病史。Kaplan-Meier生存分析结果显示,NLR3.675组患者与NLR≥3.675组患者相比具有更长的生存时间(250天vs.192天,P=0.044,HR=0.500)。PLR176.62组患者比PLR≥176.62组患者具有更长的生存时间(213 天 vs.168 天,P=0.025,HR=0.434).而 LMR(189 天 vs.201 天,P=0.350,HR=1.362)和 PNI(180 天 vs.201 天,P=0.250,HR=1.457)未显示与纳入患者的总生存率有明显相关性。NLR升高与PLR升高均与有无吸烟史存在明显相关性。Cox单变量分析结果显示NLR升高(P=0.048,HR=0.523[95%CI,0.275~0.995])与 PLR 升高(P=0.012,HR=0.417[95%CI,0.211~0.824])均与较差的预后相关,但Cox多变量分析结果显示仅PLR升高与较差的预后相关(P=0.001,HR=0.107[95%CI,0.028~0.413]),而 NLR 未在 Cox 多变量分析中显示有统计学差异(P=0.575,HR=0.727[95%CI,0.238~2.222])。结论:PLR是以吉西他滨为基础方案化疗的晚期胰腺癌病人的独立的预后因素。PLR升高与较差的预后相关。本研究中NLR、LMR和PNI未显示独立预后预测作用。
[Abstract]:Objective: a number of studies have shown that inflammation in the tumor microenvironment play an important role in the occurrence and progression of tumor, play a role in predicting the prognosis of systemic inflammatory markers of tumors. The markers of inflammation are peripheral blood neutrophil lymphocyte ratio (NLR), peripheral blood platelet and lymphocyte ratio (PLR), peripheral blood lymphocytes and mononuclear cell ratio (LMR) and the prognostic nutritional index (PNI). Yet there is no role in predicting the prognosis of reported inflammatory markers for gemcitabine based chemotherapy for advanced pancreatic cancer patients. The aim of this study is to explore the treatment inflammatory markers for the prognosis of advanced pancreatic cancer patients with gemcitabine based chemotherapy for the predictive effect. Methods: from January 2008 to July 2015 in Qilu Hospital of Shandong University received treatment with gemcitabine Capecitabine based chemotherapy for 53 cases of advanced pancreatic cancer were included in the study, collect the clinical data of patients were retrospectively analyzed. The clinical data including clinical features and chemotherapy of patients with hematological indexes. The clinical features including gender, age at diagnosis, smoking history, drinking history, history of cardiovascular disease. A history of diabetes. Blood indexes including the absolute value of the absolute value of lymphocyte, neutrophil, monocyte absolute value, the absolute value of platelet, albumin value, CEA value, CA-199 value, NLR, LMR and PNI. calculated by PLR, using ROC curve to determine NLR, PLR, LMR, PNI, 3.675176.62,2.815 respectively. 42.11. and all patients were followed up at the end of July 2016. Using the Kaplan-Meier survival analysis draw survival curves, log-rank test was used to compare the survival rate, using Cox proportional hazards regression model to assess the prognosis for The risk ratio (HR). Results: the median age of the 53 cases of the patients enrolled in the study was 60 years old, the average age (58.75 + 11.42) years old, of which 32 were male, 21 female patients. The median survival time was 192 days, all patients were clinical stage IV to.53 per capita gemcitabine based chemotherapy, of which 12 were gemcitabine chemotherapy, 26 artificial gemcitabine combined with fluoropyrimidine chemotherapy, 15 human gemcitabine combined with platinum chemotherapy.53 patients, 16 had a history of smoking, 11 had a history of alcohol, 8 had a history of diabetes mellitus, 4 people a history of coronary heart disease.Kaplan-Meier survival analysis showed that compared with longer survival time of NLR3.675 group and NLR group were more than 3.675 (250 vs.192 days, P=0.044, HR=0.500) in.PLR176.62 group is longer than the PLR more than 176.62 groups of patients with survival time (213 days vs.168 Day, P=0.025, HR=0.434). LMR (189 vs.201 days, P=0.350, HR=1.362) and PNI (180 vs.201 days, P=0.250, HR=1.457) and did not show the total survival rate of patients with.NLR was correlated with increased smoking history there is obvious correlation between.Cox single variable analysis showed that the increase of NLR with the rise of PLR (P=0.048, HR=0.523[95%CI, 0.275~0.995]) and PLR (P=0.012, HR=0.417[95%CI, elevated 0.211~0.824]) were associated with worse prognosis, but Cox multivariate analysis showed that only PLR was associated with a poor prognosis (P=0.001, HR=0.107[95,%CI, 0.028~0.413], NLR) and not in the Cox multivariate analysis showed that there were significant differences (P=0.575, HR=0.727[95%CI, 0.238~2.222]). Conclusion: PLR is an independent prognostic factor for.PLR gemcitabine based chemotherapy for advanced pancreatic cancer patients. The prognosis was associated with worse. In this study, NLR, LMR and PN I did not demonstrate the prognostic role of independent prognosis.

【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】：R735.9

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