术前凝血检测和中性粒细胞淋巴细胞比率对于非小细胞肺癌预后研究分析
发布时间：2018-08-18 15:55
【摘要】：目的1、评估术前常规凝血检测水平与非小细胞肺癌(NSCLC)患者行根治性完整切除术后总生存率的相关性。2、术前中性粒细胞淋巴细胞比率(NLR)对于行根治性切除的非小细胞肺癌(NSCLC)患者的临床意义方法选取2004年1月至2008年12月在天津医科大学肿瘤医院行完全性切除手术的NSCLC患者754例纳入凝血检测以及同期患者681例行根治性切除的非小细胞肺癌患者纳入NLR研究,利用Kruskall-Wallis和Mann-Whitney U检验,评价术前常规凝血检测水平、术前中性粒细胞淋巴细胞比率与其他变量的相关性,并且通过单变量和多变量分析确定凝血功能以及中性粒细胞淋巴细胞比率的术前水平和总体生存率之间的关联。结果1、所有术前常规凝血检测水平(血浆凝血酶原时间(PT);国际标准化比值(INR);活化部分凝血活酶时间(APTT);凝血酶时间(TT);纤维蛋白原(Fbg);D-二聚体)与NSCLC患者T分期及临床分期均存在相关性。单因素分析显示,术前凝血试验中PT(χ~2=8.254,P=0.004)和INR(χ~2=5.404,P=0.020)延长,以及异常升高的Fbg(χ~2=9.184,P=0.002)和D-二聚体(χ~2=9.184,P=0.002)水平提示预后较差。多变量模型证实术前D-二聚体为NSCLC患者预后的独立因素(P=0.019)。2、根据ROC曲线,选取2.3作为中性粒细胞淋巴细胞比率的界值。其中269名患者NLR2.3,412名患者NLR≤2.3。NLR2.3患者总体生存期(OS)是明显低于NLR≤2.3患者(34.1%VS 56.1%,P0.001)。单因素分析显示,手术方式(P=0.044),肿瘤病变部位(P=0.034),病理分期(P0.001),化疗与否(P=0.007),单核细胞(P=0.003),乳酸脱氢酶(LDH)(P0.001),纤维蛋白原(Fbg)(P=0.001),和D-二聚体(P=0.012)与5年OS率显著相关。多变量分析显示术前NLR是影响NSCLC患者的独立危险因素(P0.001;危险比:1.640;95%置信区间:1.319-2.038)。结论1、术前凝血检测中PT和INR延长以及Fbg和D-二聚体水平升高提示NSCLC患者预后不良,而术前凝血检测中D-二聚体是行根治性手术NSCLC患者的独立预后因素。2、术前NLR可作为预测行根治性切除的非小细胞肺癌患者预后的因子。
[Abstract]:Objective 1. To evaluate the correlation between preoperative routine coagulation and overall survival rate after radical complete resection in patients with non-small cell lung cancer (NSCLC). The ratio of neutrophils to lymphocytes (NLR) in patients with NSCLC after radical resection was evaluated. Clinical significance of (NSCLC) patients with lung cancer 754 patients with NSCLC underwent complete resection from January 2004 to December 2008 in Tianjin Medical University Oncology Hospital and 681 patients underwent radical resection in the same period Patients with non-small cell lung cancer were included in the NLR study. Kruskall-Wallis and Mann-Whitney U tests were used to evaluate the correlation between preoperative neutrophil lymphocyte ratio and other variables. Univariate and multivariate analysis was used to determine the relationship between preoperative level of coagulation and neutrophil lymphocyte ratio and overall survival rate. Results 1. All preoperative routine coagulation levels (plasma prothrombin time (PT); international standardized ratio (INR); activated partial thromboplastin time (APTT); thrombin time (TT); fibrinogen (Fbg) (Fbg) D-dimer) and T stage and clinical features of NSCLC patients There was correlation between stages. Univariate analysis showed that the prolongation of PT and INR in preoperative coagulation test (蠂 ~ (2) 2) and INR (蠂 ~ (2 +) 5.404), as well as the abnormal elevation of Fbg (蠂 ~ (29.184) P ~ (0.002) and D-dimer (蠂 ~ (29) ~ (184) P ~ (0.002) suggested a poor prognosis. The multivariate model confirmed that preoperative D- dimer was an independent prognostic factor in patients with NSCLC (P0. 019). According to the ROC curve, 2. 3 was selected as the limit value of neutrophil lymphocyte ratio. The overall survival time (OS) of 269 NLR2.3412 patients with NLR 鈮，
本文编号：2189955
[Abstract]:Objective 1. To evaluate the correlation between preoperative routine coagulation and overall survival rate after radical complete resection in patients with non-small cell lung cancer (NSCLC). The ratio of neutrophils to lymphocytes (NLR) in patients with NSCLC after radical resection was evaluated. Clinical significance of (NSCLC) patients with lung cancer 754 patients with NSCLC underwent complete resection from January 2004 to December 2008 in Tianjin Medical University Oncology Hospital and 681 patients underwent radical resection in the same period Patients with non-small cell lung cancer were included in the NLR study. Kruskall-Wallis and Mann-Whitney U tests were used to evaluate the correlation between preoperative neutrophil lymphocyte ratio and other variables. Univariate and multivariate analysis was used to determine the relationship between preoperative level of coagulation and neutrophil lymphocyte ratio and overall survival rate. Results 1. All preoperative routine coagulation levels (plasma prothrombin time (PT); international standardized ratio (INR); activated partial thromboplastin time (APTT); thrombin time (TT); fibrinogen (Fbg) (Fbg) D-dimer) and T stage and clinical features of NSCLC patients There was correlation between stages. Univariate analysis showed that the prolongation of PT and INR in preoperative coagulation test (蠂 ~ (2) 2) and INR (蠂 ~ (2 +) 5.404), as well as the abnormal elevation of Fbg (蠂 ~ (29.184) P ~ (0.002) and D-dimer (蠂 ~ (29) ~ (184) P ~ (0.002) suggested a poor prognosis. The multivariate model confirmed that preoperative D- dimer was an independent prognostic factor in patients with NSCLC (P0. 019). According to the ROC curve, 2. 3 was selected as the limit value of neutrophil lymphocyte ratio. The overall survival time (OS) of 269 NLR2.3412 patients with NLR 鈮，
本文编号：2189955
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