全身炎症反应相关指标预测食管癌放疗患者预后的研究

发布时间：2018-11-21 12:16

【摘要】：背景与目的:目前已有多项研究证实食管癌患者术前全身炎性反应相关指标,如粒淋比(NLR)、血淋比(PLR)、淋单比(LMR),能够预测术后食管癌患者预后。然而,NLR、PLR、LMR与接受放疗的食管癌患者的预后关系则未见报道。本研究目的是探讨全身炎性反应相关指标在食管癌放疗患者预后预测中的临床价值。资料与方法:回顾性分析2009年至2014年在山东大学齐鲁医院接受放射治疗的食管癌患者。收集其基线临床特征、放疗前1周内血液分析报告以及CT报告。粒淋比(NLR)的计算方式为食管癌患者的周围血中性粒细胞与淋巴细胞计数的绝对值之比。以此类推,血淋比(PLR)是血小板与淋巴细胞计数的绝对值之比,淋单比(LMR)的计算公式是食管癌放疗患者放疗前的周围血淋巴细胞及单核细胞计数的绝对值之比。以NLR=2为界,PLR=150为界,LMR=3.57为界,将资料分为两组进行分析。运用卡方检验分析NLR、PLR、LMR与患者基线临床特征的关系。对于NLR、PLR、LMR与患者无进展生存期(PFS)的分析,我们采用Kaplan-Meier法绘制生存曲线,并利用Log-rank检验比较差异。采用Cox比例风险模型对相关变量进行单因素分析。本研究中数据均采用SPSS23软件进行统计学分析,p0.05结果有统计学差异。结果:本研究共纳入86例患者,其中男性患者75例,女性患者11例。中位年龄63岁。中位随访时间11个月(1-68月)。中位无进展生存11个月。卡方检验显示NLR两组患者间基线临床特征均未见统计学差异;PLR两组患者间年龄上存在明显差异(p=0.005);LMR两组患者性别因素存在明显差异(p=0.036)。高NLR组中位PFS为10月,低NLR组中位PFS为12月(log-rank p=0.048)。高PLR组中位PFS为10月,低PLR组中位PFS为14.5月(log-rank p0.05)。高LMR 组中位 PFS 为 10 月,低 LMR 组中位PFS 为 11 月(log-rank p0.05)。Cox比例风险风险模型结果显示粒淋比组、血淋比组、淋单比组风险比(HR)分别为 0.56,0.65 和 1.15。结论:血淋比和淋单比不能预测接受放疗的食管癌患者PFS。放疗前粒淋比较高的食管癌患者比粒淋比较低的患者PFS短。放疗前粒淋比一定程度上可预测接受放疗的食管癌患者的预后,但这种预测效力并不强。
[Abstract]:Background & objective: several studies have confirmed that preoperative systemic inflammatory response in patients with esophageal cancer, such as granulocyte lymphocyte ratio (NLR), blood lymphocyte ratio (PLR),) to single lymphocyte ratio (LMR), can predict the prognosis of postoperative esophageal cancer patients. However, the relationship between NLR,PLR,LMR and prognosis in patients with esophageal cancer undergoing radiotherapy has not been reported. The purpose of this study was to evaluate the prognostic value of systemic inflammatory response markers in patients with esophageal cancer after radiotherapy. Materials and methods: esophageal cancer patients receiving radiotherapy from 2009 to 2014 in Qilu Hospital Shandong University were retrospectively analyzed. The baseline clinical features, blood analysis report and CT report within 1 week before radiotherapy were collected. The granulocyte ratio (NLR) was calculated as the absolute ratio of peripheral blood neutrophils to lymphocyte counts in patients with esophageal cancer. By analogy, (PLR) is the absolute ratio of platelet to lymphocyte count, and the (LMR) formula is the absolute ratio of peripheral blood lymphocytes and monocytes before radiotherapy in patients with esophageal cancer. Taking NLR=2 as the boundary, PLR=150 as the boundary, and LMR=3.57 as the boundary, the data were divided into two groups for analysis. Chi-square test was used to analyze the relationship between NLR,PLR,LMR and baseline clinical features. For the analysis of NLR,PLR,LMR and (PFS), Kaplan-Meier method was used to draw the survival curve, and Log-rank test was used to compare the difference. The Cox proportional risk model is used to analyze the related variables. In this study, the data were analyzed by SPSS23 software, p0.05 results were statistically different. Results: a total of 86 patients were included in this study, including 75 male and 11 female. The median age was 63 years. The median follow-up time was 11 months (1-68 months). Median no progress survival for 11 months. Chi square test showed that there was no statistical difference in baseline clinical characteristics between the two groups of NLR, and there was a significant difference in age between the two groups of PLR (p0. 005); LMR and 2 groups) (p0. 036). The median PFS of high NLR group was 10 months and that of low NLR group was 12 months (log-rank p0. 048). The median PFS of high PLR group was 10 months, while that of low PLR group was 14. 5 months (log-rank p 0. 05). The median PFS was 10 months in the high LMR group, and the median PFS was 11 months in the low LMR group (log-rank p0.05). Cox proportional risk model). The results showed that the (HR) of the granulocyte ratio group, the blood lymphocyte ratio group and the single lymphocyte ratio group were 0.560.65 and 1.15, respectively. Conclusion: hemolymph ratio and lymphocytic ratio can not predict PFS. in patients with esophageal cancer undergoing radiotherapy. PFS was shorter in esophageal cancer patients with higher granulocyte levels before radiotherapy than in patients with lower granulocyte lymphocytic levels. The granulocyte ratio can predict the prognosis of esophageal cancer patients who received radiotherapy to some extent, but this predictive effect is not strong.
【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】：R735.1

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