不同炎症性评分指标对根治性切除的胰腺癌患者预后的评估价值  

Prognostic value of inflammation-based scores and TNM stage for pancreatic cancer patients after radical resection

作　　者：苏子剑[1] 潘群雄[1] 王聪仁[1] 张剑华[1] 柯少迎[1] 张胜利[2] 

机构地区：[1]福建医科大学附属泉州第一医院肝胆外科,福建泉州362000 [2]福建中医药大学管理学院

出　　处：《中华胰腺病杂志》2016年第5期298-304,共7页Chinese Journal of Pancreatology

基　　金：福建省自然科学基金（2014J01435）;泉州市科技计划项目（2013258）

摘　　要：目的：比较不同炎症性评分指标对行根治性手术的胰腺癌患者预后的评估价值，并与临床上最常用的TNM分期进行比较。方法回顾性分析行根治性手术治疗的185例胰腺癌患者的临床资料。根据患者术前格拉斯哥预后评分（ GPS）、中性粒细胞／淋巴细胞比值（ NLR）、血小板／淋巴细胞比值（ PLR）、预后指数（ PI）、小野寺预后营养指数（ PNI），采用单因素、多因素分析影响患者术后生存时间的因素。不同炎症性评分指标的同质性比较采用似然比χ2检验，判别力及单一趋势性比较采用线性趋势χ2检验和受试者工作特征（ ROC）曲线，并与传统的TNM分期进行比较。结果单因素分析显示，术前消瘦，血清CRP、白蛋白、CA19-9水平，行根治性手术， NLR、PLR、GPS、PI、PNI及TNM分期均与胰腺癌患者术后1、2、3年生存率相关（P＜0．001）。多因素COX风险模型分析显示，TNM分期、行根治性手术、GPS、NLR、PLR、PI、PNI是评估胰腺癌患者术后生存时间的独立危险因素。 ROC曲线分析显示， GPS较其他炎症性评分指标有更大的曲线下面积（ AUC），而TNM分期的AUC最大。 GPS较NLR、PLR、PI、PNI具有更好的同质性、判别力及单一趋势性，而TNM分期表现更为突出。结论 GPS、NLR、PLR、PI、PNI等炎症性评分指标均为行根治性手术的胰腺癌患者预后的独立危险因素，其中GPS对预后的评估优于NLR、PLR、PI、PNI等其他炎症性评分指标。Objective To compare the prognostic value of different inflammation-based prognostic scores and Tumor Node Metastasis （ TNM） stage for patients undergoing radical resection of pancreatic cancer with the routine TNM stage in clinical practice.Methods Clinical data of 185 patients with pancreatic cancer who underwent radical surgery were retrospectively analyzed.Based on the inflammation-based prognostic scores （ Glasgow prognostic score （ GPS ） , neutrophil lymphocyte ratio （ NLR ） , platelet lymphocyte ratio （ PLR） , prognostic nutritional index （ PNI ） and prognostic index （ PI ） ） before surgery, univariate and multivariate analyses were used for identifying influential factors on patients′survival.Homogeneity of different scoring systems was compared using likelihood ratio chi-quare test, and linear trend chi-square test, and receiver operating characteristic （ ROC） curve were performed to compare the differentiating ability and single trend of the selected scores with those of routine TNM stage.Results In univariate analysis, preoperative weight loss, serum C-reactive protein, serum albumin, CA19-9, radical surgery, NLR, PLR, GPS, PI, PNIand TNM stage were all significantly associated with patients′overall survival after surgery （P〈0.001）.In multivariate cox risk model analysis, TNM stage, radical surgery, GPS, NLR, PLR, PI and PNI were independent risk factors for patients′survival after surgery.ROC curve showed that GPS had higher AUC than other scoring systems, but TNM stage had the highest AUC.The homogeneity, differentiating ability and single trend of GPS were higher compared to other inflammation-based prognostic scores, but those of TNM stage were the highest.Conclusions The inflammation-based prognostic scores like GPS, NLR, PLR, PI and PNI were independent prognostic factors for pancreatic caner patients′survival after surgery, and the prognostic value of GPS was superior to that of NLR, PLR, PI and PNI.

关 键 词：胰腺肿瘤 格拉斯哥预后评分 预后 

分 类 号：R735.9[医药卫生—肿瘤]