胃癌患者外周血中淋巴细胞/白细胞与临床病理及预后间的关系  

Study on the relationship between peripheral lymphocyte-to-white blood cell ratio and clinical pathology and prognosis among gastric cancer patients

作　　者：杨群树 胡正宇 朱勇 陆明[1] 孟翔凌[1] Yang Qunshu;Hu Zhengyu;Zhu Yong;Lu Ming;Meng Xiangling(Department of General Surgery,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China)

机构地区：[1]安徽医科大学第一附属医院普外科,合肥230022 [2]安徽医科大学第四附属医院普外科

出　　处：《中国临床保健杂志》2018年第6期739-744,共6页Chinese Journal of Clinical Healthcare

基　　金：安徽省科技计划项目(1607a0202020);安徽省高校自然科学重点研究项目(KJ2016A335)

摘　　要：目的探讨胃癌患者外周血中淋巴细胞和白细胞比例与临床病理及预后间关系。方法回顾性分析257例手术及病理确诊为胃癌患者的临床资料及术后随访。采用ROC曲线法确定中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)、单核细胞与淋巴细胞比值(MLR)、中性粒细胞与白细胞比值(NWR)、淋巴细胞与白细胞比值(LWR)、单核细胞与白细胞比值(MWR)最佳截断值,依此将患者分为高比值组和低比值组。采用Kaplan-Meier法估计生存函数,不同分组患者的生存函数比较采用Log rank检验。采用Cox风险回归模型对患者性别、年龄、症状、T分期、N分期、TNM分期、分化程度进行单因素和多因素分析来确定影响胃癌预后的因素。结果高NLR组患者的肿瘤浸润深、淋巴结转移数多和TNM分期晚。高NWR组患者的肿瘤浸润深、TNM分期晚。高NLR(χ~2=34. 21)、高MLR(χ~2=27. 77)、高PLR(χ~2=9. 23)、高NWR(χ~2=11.09)、高MWR(χ~2=5.86)和低LWR(χ~2=25.48)均与胃癌远期预后不良有关(P<0.05)。经COX回归:LWR是影响胃癌的独立危险因素(HR=0.357,95%CI:0.258～0.494,P<0.05)。结论炎性指标与胃癌患者的预后相关,且LWR是胃癌的独立预后因素。Objective To assess the prognostic significance of lymphocyte-to-white blood cell ratio(LWR) in gastric cancer. Methods Clinic pathological data of 257 patients with gastric cancer were analyzed retrospectively in this study.The optimal cutoff values of neutrophil- to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR),monocyte-to-lymphocyte ratio(MLR),neutrophil-to-white blood cell ratio(NWR),LWR and monocyte-to-white blood cell ratio(MWR) were determined by ROC curve,and the patients were divided into high and low groups.Kaplan-meier method was used to estimate the overall survival(OS),and different groups were compared by the Log rank test.Moreover,univariate and multivariate models were used to analyze the prognosis factor of gastric cancer patients. Results The tumor infiltration depth,lymph node metastasis and TNM stage were associated with high NLR group.The tumor infiltration depth and TNM stage were associated with high NWR group.High NLR(χ^2=34.21),high PLR(χ^2=9.23),high mLR(χ^2=27.77),high NWR(χ^2=11.09),high MWR(χ^2=5.86) and low LWR(χ^2=25.48) were all associated with poor prognosis of gastric cancer(P<0.05),But only LWR was an independent prognostic predictors (HR=0.357,95%CI:0.258-0.494,P<0.05). Conclusion Inflammatory markers are associated with the prognosis of patients with gastric cancer,and LWR is an independent prognostic factor.

关 键 词：胃肿瘤 淋巴细胞 白细胞 病理状态 体征和症状 预后 危险因素 

分 类 号：R735.2[医药卫生—肿瘤]