胰腺癌根治术患者术前血小板/淋巴细胞比值与临床病理特征和生存时间的相关性
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摘要
目的:探讨胰腺癌根治术患者术前血小板/淋巴细胞比值(PLR)与临床病理特征和生存时间的相关性。方法:选取2010年5月至2014年5月在我院接受胰腺癌根治术患者86例作为研究对象,采用回顾性分析法分析其临床病理资料,根据ROC曲线结果将其分为高PLR组和低PLR组,比较两组临床病理特征和术后1年生存率,采用单因素分析和Cox比例风险回归模型分析胰腺癌术后患者预后生存的相关因素。结果:ROC曲线显示,PLR预测胰腺癌根治术患者生存时间的最佳临界值为250. 2,按此临界值,高PLR组(PLR≥250. 2,40例)和低PLR组(PLR <250. 2,46例);高PLR组年龄、肿瘤T分期和肿瘤N分期均明显高于低PLR组(P <0. 05);高PLR组中位生存时间、术后1年生存率均明显低于低PLR组(P <0. 05);单因素分析显示:年龄、肿瘤T分期和肿瘤N分期、术前PLR与胰腺癌术后患者预后生存相关(P <0. 05);经多元Cox逐步回归分析,结果发现肿瘤T_(3-4)期、肿瘤N_1期、术前PLR≥250. 2均是胰腺癌术后患者预后生存的独立危险因素(P <0. 05)。结论:术前PLR与胰腺癌患者的年龄、肿瘤T分期和肿瘤N分期均密切相关,且术前高PLR水平是影响胰腺癌术后患者预后生存的独立危险因素,故可作为临床上评估胰腺癌患者预后的有效指标之一。
Objective: To investigate the correlation of preoperative platelet/lymphocyte ratio( PLR) with clinical pathological characteristics and survival time in pancreatic cancer patients with radical resection. Methods: The clinicopathological data of 86 patients who underwent radical resection of pancreatic cancer in our hospital from May 2010 to May 2014 were retrospectively analyzed. According to preoperative PLR of ROC,patients were divided into with high PLR and with low PLR. The clinicopathological features and 1-year survival rate were compared between the two groups. Univariate analysis and Cox proportional hazards regression model were used to analyze the prognostic survival factors of pancreatic cancer patients. Results: The ROC curve showed that the best critical value of PLR to predict the survival time of the patients with radical pancreatic cancer was 250. 2,according to the critical value,the high PLR group( PLR > 250. 2,40 cases) and the low PLR group( PLR < 250. 2,46 cases). The age,tumor T stage,and tumor N stage in the high PLR group were significantly higher than those in the low PLR group( P < 0. 05). The median survival time and 1-year survival rate in the high-PLR group were significantly lower than those in the low-PLR group( P < 0. 05). Univariate analysis showed that age,tumor T staging and tumor N staging,preoperative PLR were correlated with prognosis survival after pancreatic cancer( P < 0. 05). Multivariate Cox stepwise regression analysis revealed that advanced T stage lesions( T_(3-4)),advanced N stage metastasis( N_1),and PLR≥250. 2 preoperatively were all independent risk factors for prognosis survival after pancreatic cancer( P < 0. 05). Conclusion: Preoperative PLR is closely related to age,tumor T stage,and tumor N stage in patients with pancreatic cancer,and preoperative high PLR level is an independent risk factor influencing prognosis survival of pancreatic cancer patients. Therefore,it can be used as one of the effective indicators of prognosis.
Objective: To investigate the correlation of preoperative platelet/lymphocyte ratio( PLR) with clinical pathological characteristics and survival time in pancreatic cancer patients with radical resection. Methods: The clinicopathological data of 86 patients who underwent radical resection of pancreatic cancer in our hospital from May 2010 to May 2014 were retrospectively analyzed. According to preoperative PLR of ROC,patients were divided into with high PLR and with low PLR. The clinicopathological features and 1-year survival rate were compared between the two groups. Univariate analysis and Cox proportional hazards regression model were used to analyze the prognostic survival factors of pancreatic cancer patients. Results: The ROC curve showed that the best critical value of PLR to predict the survival time of the patients with radical pancreatic cancer was 250. 2,according to the critical value,the high PLR group( PLR > 250. 2,40 cases) and the low PLR group( PLR < 250. 2,46 cases). The age,tumor T stage,and tumor N stage in the high PLR group were significantly higher than those in the low PLR group( P < 0. 05). The median survival time and 1-year survival rate in the high-PLR group were significantly lower than those in the low-PLR group( P < 0. 05). Univariate analysis showed that age,tumor T staging and tumor N staging,preoperative PLR were correlated with prognosis survival after pancreatic cancer( P < 0. 05). Multivariate Cox stepwise regression analysis revealed that advanced T stage lesions( T_(3-4)),advanced N stage metastasis( N_1),and PLR≥250. 2 preoperatively were all independent risk factors for prognosis survival after pancreatic cancer( P < 0. 05). Conclusion: Preoperative PLR is closely related to age,tumor T stage,and tumor N stage in patients with pancreatic cancer,and preoperative high PLR level is an independent risk factor influencing prognosis survival of pancreatic cancer patients. Therefore,it can be used as one of the effective indicators of prognosis.
引文
[1]Yuan YD,Sun J,Li PF,et al. Values of neutrophil-lymphocyte ratio and platelet-lymphocyte ratio in predicting sensitivity to intravenous immunoglobulin in Kawasaki disease[J]. Chinese Journal of Contemporary Pediatrics,2017,19(4):410-413.[袁迎第,孙军,李鹏飞,等.中性粒细胞与淋巴细胞比值及血小板与淋巴细胞比值对于川崎病IVIG敏感性的预测价值[J].中国当代儿科杂志,2017,19(4):410-413.]
[2]Liu JH,Luo Y,Chen X,et al. Pre-radiation neutrophil to lymphocyte ratio,platelet to lymphocyte ratio,prognostic nutritional index,and CA19-9 as prognostic factors in pancreatic cancer patients treat-ed with radiotherapy[J]. Chin J Clin Oncol,2017,44(6):289-293.[刘建辉,罗妍,陈晓,等.放疗前中性粒细胞/淋巴细胞血小板/淋巴细胞预后营养指数及CA19-9与胰腺腺癌放疗后预后关系的分析[J].中国肿瘤临床,2017,44(6):289-293.]
[3]Cheng JF,Yu SA,Zheng ZD,et al. Predictive value of preoperative neutrophil to lymphocyte ratio in prognosis of pancreatic cancer patients undergoing radical surgery[J]. Zhejiang Medical Journal,2017,39(2):109-111.[程俊峰,俞世安,郑樟栋,等.术前中性粒细胞与淋巴细胞比值对可切除性胰腺癌患者预后的影响[J].浙江医学,2017,39(2):109-111.]
[4]Hong J,Mao Y,Chen X,et al. Elevated preoperative neutrophil-to-lymphocyte ratio predicts poor disease-free survival in Chinese women with breast cancer[J]. Tumor Biology,2016,37(3):4135-4142.
[5]Liu JY,Bao DZ,Xin XL,et al. Predictive values of serum CEA level in lymph node metastasis of pancreatic cancer patients[J]. Modern Oncology,2017,25(16):2629-2632.[刘俊艳,包殿芝,信学礼,等.血清CEA水平对胰腺癌患者淋巴结转移的预测价值[J].现代肿瘤医学,2017,25(16):2629-2632.]
[6]Ma JC,Yao JB,Yang J,et al. Relationship of para-aortic lymph nodes(PALN)status with prognosis and clinicopathological features of pancreatic cancer patients after pancreatectomy[J]. Cancer Research on Prevention and Treatment,2017,44(10):665-671.[马继春,姚继彬,杨健,等.胰腺癌患者胰腺切除术后腹主动脉旁淋巴结状态与其预后及临床病理特征的关系[J].肿瘤防治研究,2017,44(10):665-671.]
[7]Zhang DF,Wu QF,Ge CZ,et al. Prognostic value of tumor marker CA19-9 and CA242 in pancreatic cancer metastasis and prognosis[J]. Modern Oncology,2017,25(8):1258-1260.[张定富,吴秋芳,戈长征,等.肿瘤标记物CA19-9、CA242对胰腺癌转移和预后预测价值的分析[J].现代肿瘤医学,2017,25(8):1258-1260.]
[8]Liu JW,Lu Y,Shen GL,et al. The relationship of B7-H1 with clinicopathologic characteristics and prognosis of pancreatic carcinoma[J]. Chinese Journal of General Practice,2016,14(4):571-574.[刘军伟,卢毅,沈国樑,等. B7-H1与胰腺癌临床病理学特征和预后的关系[J].中华全科医学,2016,14(4):571-574.]
[9]Shi G,Zhao JW,Ming L,et al. Clinical significance of peripheral blood neutrophil-lymphocyte ratio and platelet-lymphocyte ratio in patients with asthma[J]. Journal of Southern Medical University,2017,37(1):84-88.[时光,赵俊伟,明亮,等.哮喘患者外周血血小板-淋巴细胞比值和中性粒细胞-淋巴细胞比值的临床意义[J].南方医科大学学报,2017,37(1):84-88.]
[10]Lei T,Jia FX,Liu JW,et al. Expression and significance of Survivin and u PA and their correlation in pancreatic carcinoma[J].Chinese Journal of Clinical and Experimental Pathology,2016,32(10):1093-1097.[雷霆,贾富鑫,刘江伟,等.存活素和尿激酶型纤溶酶原激活剂在人胰腺癌组织中的表达意义及相关性分析[J].临床与实验病理学杂志,2016,32(10):1093-1097.]
[11]Ji YF,Jiang F,Liu ZX,et al. Expression and correlation of S100A11 and TGF-β1 protein in pancreatic cancer[J]. Shandong Medical Journal,2017,57(25):58-60.[纪易斐,江枫,刘肇修,等.胰腺癌组织中S100A11、TGF-β1蛋白的表达变化及其相关性[J].山东医药,2017,57(25):58-60.]
[12]Ni J,Wang YQ,Zhang YP,et al. Value of neutrophil/lymphocyte ratio and platelet/lymphocyte ratio for prognostic evaluation of diffuse large B-cell lymphoma[J]. Journal of Experimental Hematology,2016,24(2):427-432.[倪婧,王永庆,张英平,等.中性粒细胞/淋巴细胞比值和血小板/淋巴细胞比值在弥漫大B细胞淋巴瘤预后判断中的意义[J].中国实验血液学杂志,2016,24(2):427-432.]
[13]Wang J,Zhao L,Che JJ,et al. Correlation analysis of plasma DDimer level with survival and prognosis in stageⅣpancreatic cancer patients[J]. International Journal of Pathology and Clinical Medicine,2016,36(5):568-573.[王婧,赵磊,车娟娟,等. D-Dimer与胰腺癌Ⅳ期患者生存期及预后的相关性研究[J].临床与病理杂志,2016,36(5):568-573.]
[14]Meng Y,Zhu Y,Zhang YQ,et al. Expression of cysteinyl leukotriene receptor-1 in pancreatic cancer tissue and its clinical significance[J]. Journal of Clinical and Pathology,2017,33(1):133-136.[孟艳,朱莹,张亚庆,等.半胱氨酰白三烯受体1在胰腺癌组织中的表达及临床意义[J].临床肝胆病杂志,2017,33(1):133-136.]
[15]Wang P,Lang HB,Liu XJ,et al. Expression of Smad4 in cancer tissue of pancreatic cancer patients and its relationship with prognosis[J]. China Medicine,2016,11(7):1034-1037.[王平,郎海波,刘心娟,等.胰腺癌患者癌组织中Smad4的表达及其与预后的关系[J].中国医药,2016,11(7):1034-1037.]
[16]Uesaka K,Boku N,Fukutomi A,et al. Adjuvant chemotherapy of S-1 versus gemcitabine for resected pancreatic cancer:a phase 3,open-label,randomised,non-inferiority trial(JASPAC 01)[J]. Lancet,2016,388(10041):248-257.
[17]Jia GR,Zhang J,Cheng C,et al. Application of18F-FDG PET/CT metabolic parameters in differentiating focal autoimmune pancreatitis from pancreatic cancer[J]. Chin J Pancreatol,2016,16(2):93-97.[贾国荣,张建,程超,等.18F-FDGPET/CT代谢参数在局灶性自身免疫性胰腺炎和胰腺癌鉴别诊断中的应用[J].中华胰腺病杂志,2016,16(2):93-97.]
[18]Hu YH,Wang ZY,Cui RR,et al. Predictive value of neutrophilto-lymphocyte ratio and platelet-to-lymphocyte ratio on recurrence and metastasis of breast cancer and influencing factors on breast cancer prognosis[J]. Chinese General Practice,2016,19(30):3657-3661.[胡赟宏,王铮元,崔嵘嵘,等.中性粒细胞/淋巴细胞比值与血小板/淋巴细胞比值对乳腺癌复发转移的预测价值及乳腺癌预后影响因素研究[J].中国全科医学,2016,19(30):3657-3661.]
[19]He CB,Lin XJ. Correlation of neutrophils to lymphocyte ratio and platelet to lymphocyte ratio with prognosis of hepatocellular carcinoma patients treated with transarterial chemoembo-lization[J].Chin J Clin Oncol,2017,44(6):283-288.[何朝滨,林小军.中性粒细胞/淋巴细胞比值血小板/淋巴细胞比值与TACE治疗肝癌患者预后的相关性[J].中国肿瘤临床,2017,44(6):283-288.]
[20]Wang J,Lin XM,Zhang JH,et al. Prediction of survival time of breast cancer patients being infected after surgery by neutrophil lymphocyte ratio and the ratio of platelet cells[J]. Chinese Journal of Hospital Infection,2016,26(14):3235-3237.[王健,林晓萌,张军华,等.中性粒细胞淋巴细胞比率及血小板淋巴细胞比率在乳腺癌合并感染患者术后生存期的预测研究[J].中华医院感染学杂志,2016,26(14):3235-3237.]
[2]Liu JH,Luo Y,Chen X,et al. Pre-radiation neutrophil to lymphocyte ratio,platelet to lymphocyte ratio,prognostic nutritional index,and CA19-9 as prognostic factors in pancreatic cancer patients treat-ed with radiotherapy[J]. Chin J Clin Oncol,2017,44(6):289-293.[刘建辉,罗妍,陈晓,等.放疗前中性粒细胞/淋巴细胞血小板/淋巴细胞预后营养指数及CA19-9与胰腺腺癌放疗后预后关系的分析[J].中国肿瘤临床,2017,44(6):289-293.]
[3]Cheng JF,Yu SA,Zheng ZD,et al. Predictive value of preoperative neutrophil to lymphocyte ratio in prognosis of pancreatic cancer patients undergoing radical surgery[J]. Zhejiang Medical Journal,2017,39(2):109-111.[程俊峰,俞世安,郑樟栋,等.术前中性粒细胞与淋巴细胞比值对可切除性胰腺癌患者预后的影响[J].浙江医学,2017,39(2):109-111.]
[4]Hong J,Mao Y,Chen X,et al. Elevated preoperative neutrophil-to-lymphocyte ratio predicts poor disease-free survival in Chinese women with breast cancer[J]. Tumor Biology,2016,37(3):4135-4142.
[5]Liu JY,Bao DZ,Xin XL,et al. Predictive values of serum CEA level in lymph node metastasis of pancreatic cancer patients[J]. Modern Oncology,2017,25(16):2629-2632.[刘俊艳,包殿芝,信学礼,等.血清CEA水平对胰腺癌患者淋巴结转移的预测价值[J].现代肿瘤医学,2017,25(16):2629-2632.]
[6]Ma JC,Yao JB,Yang J,et al. Relationship of para-aortic lymph nodes(PALN)status with prognosis and clinicopathological features of pancreatic cancer patients after pancreatectomy[J]. Cancer Research on Prevention and Treatment,2017,44(10):665-671.[马继春,姚继彬,杨健,等.胰腺癌患者胰腺切除术后腹主动脉旁淋巴结状态与其预后及临床病理特征的关系[J].肿瘤防治研究,2017,44(10):665-671.]
[7]Zhang DF,Wu QF,Ge CZ,et al. Prognostic value of tumor marker CA19-9 and CA242 in pancreatic cancer metastasis and prognosis[J]. Modern Oncology,2017,25(8):1258-1260.[张定富,吴秋芳,戈长征,等.肿瘤标记物CA19-9、CA242对胰腺癌转移和预后预测价值的分析[J].现代肿瘤医学,2017,25(8):1258-1260.]
[8]Liu JW,Lu Y,Shen GL,et al. The relationship of B7-H1 with clinicopathologic characteristics and prognosis of pancreatic carcinoma[J]. Chinese Journal of General Practice,2016,14(4):571-574.[刘军伟,卢毅,沈国樑,等. B7-H1与胰腺癌临床病理学特征和预后的关系[J].中华全科医学,2016,14(4):571-574.]
[9]Shi G,Zhao JW,Ming L,et al. Clinical significance of peripheral blood neutrophil-lymphocyte ratio and platelet-lymphocyte ratio in patients with asthma[J]. Journal of Southern Medical University,2017,37(1):84-88.[时光,赵俊伟,明亮,等.哮喘患者外周血血小板-淋巴细胞比值和中性粒细胞-淋巴细胞比值的临床意义[J].南方医科大学学报,2017,37(1):84-88.]
[10]Lei T,Jia FX,Liu JW,et al. Expression and significance of Survivin and u PA and their correlation in pancreatic carcinoma[J].Chinese Journal of Clinical and Experimental Pathology,2016,32(10):1093-1097.[雷霆,贾富鑫,刘江伟,等.存活素和尿激酶型纤溶酶原激活剂在人胰腺癌组织中的表达意义及相关性分析[J].临床与实验病理学杂志,2016,32(10):1093-1097.]
[11]Ji YF,Jiang F,Liu ZX,et al. Expression and correlation of S100A11 and TGF-β1 protein in pancreatic cancer[J]. Shandong Medical Journal,2017,57(25):58-60.[纪易斐,江枫,刘肇修,等.胰腺癌组织中S100A11、TGF-β1蛋白的表达变化及其相关性[J].山东医药,2017,57(25):58-60.]
[12]Ni J,Wang YQ,Zhang YP,et al. Value of neutrophil/lymphocyte ratio and platelet/lymphocyte ratio for prognostic evaluation of diffuse large B-cell lymphoma[J]. Journal of Experimental Hematology,2016,24(2):427-432.[倪婧,王永庆,张英平,等.中性粒细胞/淋巴细胞比值和血小板/淋巴细胞比值在弥漫大B细胞淋巴瘤预后判断中的意义[J].中国实验血液学杂志,2016,24(2):427-432.]
[13]Wang J,Zhao L,Che JJ,et al. Correlation analysis of plasma DDimer level with survival and prognosis in stageⅣpancreatic cancer patients[J]. International Journal of Pathology and Clinical Medicine,2016,36(5):568-573.[王婧,赵磊,车娟娟,等. D-Dimer与胰腺癌Ⅳ期患者生存期及预后的相关性研究[J].临床与病理杂志,2016,36(5):568-573.]
[14]Meng Y,Zhu Y,Zhang YQ,et al. Expression of cysteinyl leukotriene receptor-1 in pancreatic cancer tissue and its clinical significance[J]. Journal of Clinical and Pathology,2017,33(1):133-136.[孟艳,朱莹,张亚庆,等.半胱氨酰白三烯受体1在胰腺癌组织中的表达及临床意义[J].临床肝胆病杂志,2017,33(1):133-136.]
[15]Wang P,Lang HB,Liu XJ,et al. Expression of Smad4 in cancer tissue of pancreatic cancer patients and its relationship with prognosis[J]. China Medicine,2016,11(7):1034-1037.[王平,郎海波,刘心娟,等.胰腺癌患者癌组织中Smad4的表达及其与预后的关系[J].中国医药,2016,11(7):1034-1037.]
[16]Uesaka K,Boku N,Fukutomi A,et al. Adjuvant chemotherapy of S-1 versus gemcitabine for resected pancreatic cancer:a phase 3,open-label,randomised,non-inferiority trial(JASPAC 01)[J]. Lancet,2016,388(10041):248-257.
[17]Jia GR,Zhang J,Cheng C,et al. Application of18F-FDG PET/CT metabolic parameters in differentiating focal autoimmune pancreatitis from pancreatic cancer[J]. Chin J Pancreatol,2016,16(2):93-97.[贾国荣,张建,程超,等.18F-FDGPET/CT代谢参数在局灶性自身免疫性胰腺炎和胰腺癌鉴别诊断中的应用[J].中华胰腺病杂志,2016,16(2):93-97.]
[18]Hu YH,Wang ZY,Cui RR,et al. Predictive value of neutrophilto-lymphocyte ratio and platelet-to-lymphocyte ratio on recurrence and metastasis of breast cancer and influencing factors on breast cancer prognosis[J]. Chinese General Practice,2016,19(30):3657-3661.[胡赟宏,王铮元,崔嵘嵘,等.中性粒细胞/淋巴细胞比值与血小板/淋巴细胞比值对乳腺癌复发转移的预测价值及乳腺癌预后影响因素研究[J].中国全科医学,2016,19(30):3657-3661.]
[19]He CB,Lin XJ. Correlation of neutrophils to lymphocyte ratio and platelet to lymphocyte ratio with prognosis of hepatocellular carcinoma patients treated with transarterial chemoembo-lization[J].Chin J Clin Oncol,2017,44(6):283-288.[何朝滨,林小军.中性粒细胞/淋巴细胞比值血小板/淋巴细胞比值与TACE治疗肝癌患者预后的相关性[J].中国肿瘤临床,2017,44(6):283-288.]
[20]Wang J,Lin XM,Zhang JH,et al. Prediction of survival time of breast cancer patients being infected after surgery by neutrophil lymphocyte ratio and the ratio of platelet cells[J]. Chinese Journal of Hospital Infection,2016,26(14):3235-3237.[王健,林晓萌,张军华,等.中性粒细胞淋巴细胞比率及血小板淋巴细胞比率在乳腺癌合并感染患者术后生存期的预测研究[J].中华医院感染学杂志,2016,26(14):3235-3237.]