术前NLR及PLR与胃癌淋巴结转移的相关性研究

发布时间：2018-04-22 12:40

  本文选题：胃癌 + 淋巴结转移　； 参考：《山西医科大学》2017年硕士论文

【摘要】：目的:本研究旨在探索术前中性粒细胞-淋巴细胞比值(NLR)及血小板-淋巴细胞比值(PLR)与胃癌病理特征及淋巴结转移的相关性,并分析其在淋巴结转移评估中的意义。方法:采用回顾性病例对照研究方法。收集2014年6月至2016年12月于山西省人民医院普通外科接受手术的150例原发胃癌患者的资料。基本资料:性别、年龄;术前外周血指标包括中性粒细胞数(NEU)、淋巴细胞数(LYM)、血小板计数(PLT)、并计算其比值NLR(中性粒细胞-淋巴细胞数之比)、PLR(血小板-淋巴细胞数之比);病理学指标:肿瘤位置(贲门胃底、胃体、胃窦)、大小、浸润深度(T1-T2、T3-T4)、组织学类型(腺癌、印戒细胞癌、粘液腺癌等)、分化程度(低、中-高分化)、区域淋巴结转移情况,肿瘤TNM分期。首先用ROC曲线评估术前NLR、PLR的临床效用,确定最佳截值并分高、低组,比较两者与病例特征的相关性。然后分析与淋巴结转移相关的单因素,在此基础上进行logistic回归分析,确定影响淋巴结转移的独立因素,并初步分析NLR、PLR在胃癌淋巴结转移中的意义。结果:纳入本研究的150例原发胃癌患者中,男性98例(65.33%),女性52例(34.67%),平均年龄为59.84±10.66岁(范围31-84岁),癌肿直径平均值为3.98±1.46cm。贲门胃底癌43例(28.67%),胃体癌39例(26%),胃窦癌68例(45.33%)。病检显示:136例(90.67%)为腺癌,14例(9.33%)为印戒细胞癌、粘液腺癌、腺鳞癌及其他类型;低分化113例(75.33%),术后分期:Ⅰ-Ⅱ期患者44例(29.33%),Ⅲ-Ⅳ期患者106例(70.67%)。分析结果显示,术前NLR、PLR与性别、肿瘤位置、组织学类型、分化程度无关(P0.05),高NLR患者年龄大、肿瘤大、浸润深、淋巴结转移率及TNM分期更高(P0.05),PLR也随着年龄、癌肿的增大及肿瘤的进展明显增高(P0.05)。本组患者平均淋巴结转移率为68.0%,单因素分析表明:癌肿大小、分化程度、浸润深度、NLR、PLR均与淋巴结转移相关(P0.05),且淋巴结转移阳性者NLR、PLR明显增高。多因素分析显示,肿瘤大小、浸润深度、分化程度是胃癌淋巴结转移的独立危险因素。术前NLR及PLR对胃癌淋巴结转移的评估有一定的参考价值。结论:在胃癌中,术前NLR、PLR是与癌肿大小、浸润深度、淋巴结转移及TNM分期相关联的生物学指标,癌肿大小、浸润深度、分化程度是胃癌淋巴结转移的独立危险因素,NLR、PLR对术前淋巴结转移的评估及术中清扫中可能有一定的价值。
[Abstract]:Objective: to investigate the relationship between preoperative neutrophil / lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) and the pathological features and lymph node metastasis of gastric cancer, and to analyze its significance in the evaluation of lymph node metastasis. Methods: a retrospective case-control study was conducted. From June 2014 to December 2016, 150 patients with primary gastric cancer who underwent surgery in general surgery of Shanxi Provincial people's Hospital were collected. Basic information: sex, age; Preoperative peripheral blood parameters included neutrophils, lymphocyte count, platelet count and platelet count, and calculated the ratio of neutrophil to lymphocyte number and the ratio of neutrophil to lymphocyte; pathological parameters: tumor location (the fundus of cardia and stomach), the ratio of neutrophil to lymphocyte and the ratio of neutrophil to lymphocyte. Gastric body, antrum, size, depth of invasion, histological type (adenocarcinoma, signet ring cell carcinoma, mucinous adenocarcinoma, etc.), differentiation degree (low, medium-high differentiation, regional lymph node metastasis, TNM stage of the tumor). The ROC curve was used to evaluate the clinical efficacy of NLRL PLR before operation, and the optimal cut-off value was determined and divided into high and low groups, and the correlation between the two groups and the characteristics of the cases was compared. Based on the analysis of the single factor associated with lymph node metastasis, logistic regression analysis was carried out to determine the independent factors affecting lymph node metastasis, and the significance of NLR-PLR in lymph node metastasis of gastric cancer was preliminarily analyzed. Results: of the 150 patients with primary gastric cancer, 98 were male and 52 were female, with an average age of 59.84 卤10.66 years (range 31-84 years, mean diameter of cancer 3.98 卤1.46 cm). There were 43 cases of gastric fundus carcinoma, 39 cases of gastric body carcinoma and 68 cases of antral carcinoma. The pathological examination showed that 14 cases (9. 33%) were adenocarcinomas, including signet ring cell carcinoma, mucinous adenocarcinoma, adenosquamous carcinoma and other types, and 113 cases with low differentiation (75.33%) and 44 cases with stage 鈪，

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