根治性手术非小细胞肺癌患者手术前后NLR及其变化与预后的关系

发布时间：2019-02-22 21:26

【摘要】：研究背景:肿瘤一直是困扰人类健康,影响人口平均寿命的主要因素之一。根据2012年全球癌症报告,肺癌是目前全世界范围内发病率及死亡率位居首位的恶性癌症类型,其中非小细胞肺癌(NSCLC)占所有肺癌人数的大约80%,给人类生命健康造成了严重威胁。随着医学知识的不断进步,医疗水平的不断提高,各种治疗方法已有效延长了肺癌患者的生存期,但其预后仍不乐观。发现准确高效的肺癌患者预后评判有关指标,可以协助临床医生准确筛查出高危患者,及时给以必要的辅助治疗,可以有效提高NSCLC患者的5年生存率及生活质量,对临床工作有重大意义。研究目的:近年来,越来越多的科研结果显示,肿瘤的出现、进展与机体炎症因素密切相关,其中中性粒细胞-淋巴细胞比值(NLR)被认为与多种肿瘤,包括肺癌、肝细胞肝癌、结直肠恶性肿瘤、胃恶性肿瘤的预后密切相关。然而目前,大多数研究关注于患者手术前NLR与肺癌预后的关系,而较少关注患者术后NLR及其变化情况与预后是否相关。本研究的目的是在根治性手术的NSCLC患者中,评估手术前、后的NLR值、NLR变化值、变化率与患者生存时间的关系,并探讨其临床应用价值。研究方法:收集自2009年12月至2011年08月在山东大学齐鲁医院胸外科行非小细胞肺癌根治性切除术的87例患者进行回顾性研究。纳入我们研究中的所有患者均需符合研究预先设定的入组标准。统计肿瘤患者的发病年龄、性别、是否有吸烟不良习惯以及手术方式、肿瘤所在部位、TNM分期、肿瘤病理类型及分化程度、肿瘤转移阳性淋巴结数量,收集患者手术前一周内及手术后一个月以上在本院完成的血常规数据,根据中性粒细胞(NEU)绝对数、淋巴细胞(LY)绝对数等相关指标计算各期NLR。术前以NLR=2.71将患者分为高NLR组和低NLR组。术后以NLR=3.62将患者分为高NLR组和低NLR组。运用Kaplan-Meier法进行生存分析,以log-rank检验分析两组差异,以比较各临床因素组间患者无病生存期(DFS)和总生存时间(OS)的差异,进一步采用COX回归分析,分析各因素与患者DFS和OS的关系。所有数据在spss 24.0统计学软件完成,P0.05为组间差异有意义。结果:在一般资料中,吸烟习惯是影响根治性手术NSCLC病人预后的因素(P0.05)。手术方式、TNM分期以及肿瘤转移阳性淋巴结数量是影响患者预后的临床有关指标(P0.05)。炎症相关指标中,手术前NLR值(χ2=4.663,P=0.031)、手术后 NLR 值(χ2=23.248,P=0.001)、NLR 变化值(χ2=20.801,P0.001)、NLR变化率(χ2=10.936,P=0.001)均是NSCLC患者预后的影响因素。但将上述有关因素纳入COX回归分析中结果示:仅肿瘤转移阳性淋巴结数量及NLR变化值是预后的独立不良预测指标。结论:经过本研究发现,不仅手术前NLR为根治性手术的NSCLC患者预后的评估指标,并且手术后NLR及NLR变化值、变化率均可以作为患者DFS及OS的评估指标,且后三者对于根治性手术的NSCLC患者预后的预测效果优于手术前NLR的作用。由于NLR的获取仅需要血常规结果,而每个患者手术前、放化疗前或复查时均需要行血液学检查,是一种简便、廉价、快捷的评估指标。在未来的治疗工作中,临床医生可以根据NLR参数,将根治性手术的NSCLC患者分为高、低风险组,并由此给与患者个体化的最佳治疗。
[Abstract]:Background: The tumor has been one of the main factors for human health and the average life span of the population. According to the 2012 global cancer report, lung cancer is the first type of malignant cancer currently in the world, with non-small cell lung cancer (NSCLC) accounting for about 80% of all lung cancer, posing a serious threat to human health. With the development of medical knowledge and the continuous improvement of medical level, various treatment methods have effectively prolonged the survival of patients with lung cancer, but their prognosis is still not optimistic. It is found that the relevant index of the prognosis of the accurate and high-efficiency lung cancer patients can assist the clinician in the accurate screening of high-risk patients, and timely give the necessary auxiliary treatment, which can effectively improve the 5-year survival rate and the quality of life of the patients with NSCLC, and has great significance for clinical work. Objective: In recent years, more and more scientific research results show that the occurrence and progression of the tumor are closely related to the inflammatory factors of the body, in which the ratio of the neutrophil-lymphocyte ratio (NLR) is considered to be related to a variety of tumors, including lung cancer, hepatocellular carcinoma, colorectal malignant tumor, The prognosis of gastric malignant tumor is closely related. However, at present, most studies focus on the relationship between the NLR and the prognosis of the lung cancer before the operation of the patient, and less attention to whether the postoperative NLR and the change of the patient are related to the prognosis. The purpose of this study was to evaluate the relationship between the value of the NLR, the change of the NLR, the rate of change and the patient's survival time in the patients with NSCLC who underwent radical operation, and to discuss the value of the clinical application. Methods: 87 patients who underwent radical resection of non-small cell lung cancer in Qilu Hospital of Shandong University from December 2009 to August 2011 were retrospectively studied. All patients included in our study need to meet the pre-set enrollment criteria for the study. the incidence age, the sex, the bad habit of smoking, the mode of operation, the location of the tumor, the TNM stage, the type of the tumor and the degree of differentiation, the number of the positive lymph nodes of the tumor metastasis, The blood routine data completed in our hospital within one week prior to the operation of the patient and more than one month after the operation were collected, and the NLR was calculated according to the absolute number of the Neutrophil (NEU) and the absolute number of lymphocytes (LY). The patient was divided into a high NLR group and a low NLR group prior to the procedure with the NLR = 2.71. The patient was divided into a high NLR group and a low NLR group after operation with NLR = 3.62. The survival analysis was carried out by the Kaplan-Meier method, and the difference of the two groups was analyzed by log-rank test to compare the difference between the disease-free survival time (DFS) and the total survival time (OS) among the groups of the clinical factors, and the relationship between the factors and the patient's DFS and OS was analyzed by using the COX regression analysis. All the data were completed in the ss-24.0statistical software, and the difference between the groups was significant. Results: In general data, the habit of smoking is a factor that affects the prognosis of patients with radical operation NSCLC (P0.05). The number of operative, TNM staging and the number of positive lymph nodes in tumor metastasis was a clinical-related index that affected the prognosis of the patients (P0.05). The value of NLR (Sup2 = 4.663, P = 0.031), NLR (Sup2 = 2.801, P = 0.001), and NLR (Sup2 = 10.936, P = 0.001) were the factors influencing the prognosis of NSCLC patients. However, the above related factors were included in the results of the COX regression analysis: only the number of positive lymph nodes and the value of the NLR change in the tumor metastasis were the independent predictors of the prognosis. Conclusion: The results of this study show that not only the pre-operative NLR is the evaluation index of the prognosis of patients with NSCLC, and the change of NLR and NLR after operation can be used as the evaluation index of DFS and OS of the patients. and the prognosis of the patients with NSCLC after radical operation is superior to that of the NLR before operation. Because the acquisition of the NLR only needs the blood routine result, it is a simple, cheap and fast evaluation index for each patient before and after the operation, before and after the radiotherapy and chemotherapy or in the review. In future treatment, the clinician can divide the patients with NSCLC who have undergone radical surgery into high and low risk groups according to the NLR parameters and thereby provide the patient with the best treatment.
【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】：R734.2

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