术前血小板／淋巴细胞比值对行根治性切除术的胃混合性腺神经内分泌癌患者预后的评估价值  

Assessment value of preoperative gastric mixed platelet-lymphocyte ratio in the prognosis of patients with e carcinoma

作　　者：曹龙龙[1] 陆俊[1] 林建贤[1] 郑朝辉[1] 李平[1] 谢建伟[1] 王家镔[1] 陈起跃[1] 林密[1] 涂儒鸿 黄昌明[1] 

机构地区：[1]福建医科大学附属协和医院胃外科,福州350001

出　　处：《中华胃肠外科杂志》2016年第11期1252-1257,共6页Chinese Journal of Gastrointestinal Surgery

基　　金：国家重点临床专项建设项目

摘　　要：目的探讨术前血小板／淋巴细胞比值（PLR）对胃混合性腺神经内分泌癌（gMANEC）行根治性切除术后患者预后的评估价值。方法回顾性分析2006-2016年间福建医科大学附属协和医院胃外科行根治性切除术的84例gMANEC患者的临床病理资料。应用受试者工作特征（ROC）曲线确定术前血PLR预测预后的最佳截点值，采用Cox回归模型评估PLR对gMANEC患者预后的预测价值。结果全组患者均行D2淋巴结清扫，其中行根治性远端胃大部切除26例。根治性全胃切除58例。术后病理TNM分期（pTNM），Ⅰ期者9例（10．7％），Ⅰ／期14例（16．7％），Ⅲ期61例（72．6％）。术后中位随访时间为40（3～96）月。肿瘤复发率为41．7％（35／84），中位复发时间为10（1-40）月，有82．9％（29／35）的患者肿瘤复发于术后2年内。全组中位生存时间为27（3-96）月，中位无复发生存时间为21（1—96）月；1、3、5年总体生存率分别为87．6％、56．6％和47．4％。无复发生存率分别为70．5％、50．7％和44．9％。ROC曲线确定术前血PLR对预后的最佳截点值为133，全组84例患者中，PLR≤133者28例（低PLR组），PLR〉133者56例（高PLR组）。高PLR组术后肿瘤复发率为50．0％（28／56），明显高于低PLR组的25．0％（7／28）（P=0．028）；而高PLR组术后肝脏转移率为35．7％（20／56），也明显高于低PLR组的10．7％（3／28）（P=0．015）。多因素分析结果显示，肿瘤TNM分期（P=0．003）为影响本组患者总体生存的独立预后因素；肿瘤TNM分期（P=0．000）和血PLR（P=0．015）为影响本组患者无复发生存的独立预后因素。结论术前血PLR高的gMANEC患者术后容易发生复发和转移，尤以肝脏转移发生率高。术后应加强密切随访。Objective To explore the prognostic assessment value of preoperative blood platelet- lymphocyte ratio （PLR） in patients with gastric mixed adenoneuroendocrine carcinoma （gMANEC） treated with radical surgery. Methods Clinical and pathological data of 84 gMANEC patients who underwent radical resection from 2006 to 2016 in Department of Gastric Surgery, Fujian Medical University Union Hospital were analyzed retrospectively. Receiver operating characteristic （ROC） curve analysis was performed to determine the cutoff value of the PLR for predicting prognosis. The Cox proportional hazards regression model was used to identify prognostic factors of gMANEC. Results All the patients underwent D2 lymph node dissection, including 26 cases of distal subtotal gastrectomy and 58 cases of total gastrectomy. The postoperative pathological TNM stage system （pTNM） demonstrated that the patients of stage Ⅰ , Ⅱ, and m were 9 （10.7%）, 14 （16.7%）, and 61 （72.6%） cases, respectively. The median follow-up time was 40（3 to 96） months. The recurrence rate was 41.7%（35/84）. The median time to recurrence was 10 （1 to 40） months, and 82.9%（29/35） patients experienced recurrence within the first 2 years after operation. The median overall survival time was 27 （3 to 39） month, and the median recurrence-free survival time was 21 （1 to 96） months. The 1-, 3-, and 5-year overall survival（OS） rates were 87.6%, 56.6%, and 47.4%, respectively, and the 1-, 3-, and 5-year recurrence-free survival （RFS） rates were 70.5%, 50.7%, and 44.9%, respectively. The best cutoff value of the PLR for predicting prognosis was 133 through ROC curve, which categorized all the patients into low PLR group （≤ 133） comprising 28 patients and high PLR group （〉133） comprising 56 patients. The tumor recurrence rate was significantly higher in high PLR group （50.0%, 28/56） than that in low PLR group（25.0%, 7/28）（P= 0.028）. The live metastasis rate was significantly higher in high PLR grou

关 键 词：胃混合性腺神经内分泌癌 血小板-淋巴细胞比值 肿瘤复发 预后 

分 类 号：R735.2[医药卫生—肿瘤]