术前炎症免疫相关指标对胰腺腺鳞癌患者的预后预测价值分析  

Analysis of prognostic values of preoperative inflammatory-and immune-related indicators in patients with adenosquamous carcinoma of the pancreas

作　　者：张国虓 尹笑逸 李勃 沈硕 高绥之 王欢 时霄寒 刘武超 郭世伟 金钢 ZHANG Guoxiao;YIN Xiaoyi;LI Bo;SHEN Shuo;GAO Suizhi;WANG Huan;SHI Xiaohan;LIU Wuchao;GUO Shiwei;JIN Gang(Department of Hepatobiliary Pancreatic Surgery,Changhai Hospital Affiliated to the Naval Medical University of Chinese People's Liberation Army,Shanghai 200433,China;Department of General Surgery,the 72nd Group Army Hospital of Chinese People's Liberation Army,Huzhou,Zhejiang 313099,China)

机构地区：[1]中国人民解放军海军军医大学长海医院肝胆胰外科,上海200433 [2]中国人民解放军陆军第七十二集团军医院普通外科,浙江湖州313099

出　　处：《中国普通外科杂志》2022年第3期310-318,共9页China Journal of General Surgery

基　　金：上海申康医院发展中心疑难疾病精准诊治攻关基金资助项目(SHDC2020CR2001A)。

摘　　要：背景与目的:胰腺腺鳞癌(ASCP)为一种罕见的外分泌型恶性肿瘤,恶性程度高,根治术后预后差。目前基于TNM分期的胰腺癌预后模型并不适用于ASCP,结合其他临床数据建立适用于ASCP的预后预测模型是目前亟待解决的问题。本研究探讨术前炎症免疫相关指标[中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)、淋巴细胞与单核细胞比值(LMR)、系统免疫炎症指数(SII)]在ASCP患者术后预后评估中的作用,并建立ASCP的预后预测模型。方法:回顾性分析2012年9月—2019年9月在中国人民解放军海军军医大学长海医院肝胆胰腺外科行根治性切除术的129例ASCP患者的临床资料和随访记录。通过最小P值法分析得出NLR、PLR、LMR和SII的最佳截断值,根据各指标最佳截断值将患者分组比较预后差异,并选择性比较高SII组与低SII组患者基线特征的差异。用单变量与多变量Cox回归分析确定患者的预后因素,并构建预后指数(PI)预后预测模型,用受试者工作特征曲线(ROC)分析并比较PI预后预测模型与TNM分期预后预测模型对患者2年期生存情况预测效能。结果:NLR、PLR、LMR和SII的最佳截断值分别为3.46、85.5、4.1、339.7,按各指标最佳截断值分组,患者的生存差异均有统计学意义(均P<0.05)。高SII组肿瘤位于胰头患者的比例(47.3%vs.26.3%)与低分化肿瘤患者的比例(63.6%vs.42.1%)均高于低SII组,但差异均无统计学意义(均P>0.05)。单变量分析结果显示,T分期、N分期、肿瘤分化、肿瘤大小、脉管癌栓、神经侵犯、NLR、PLR、LMR、SII均是ASCP患者术后预后的影响因素(均P<0.05);多变量Cox回归分析结果显示,N分期、肿瘤分化、肿瘤大小、神经侵犯、SII是ASCP患者术后独立预后因素(均P<0.05)。基于独立预后因素构建PI预测模型的预测效果优于TNM分期预后预测模型(AUC:0.779 vs.0.625)。结论:术前NLR、PLR、LMR、SII对评估ASCP患�Background and Aims:Adenosquamous carcinoma of the pancreas(ASCP)is a rare exocrine malignant tumor,with a high malignancy grade and a poor prognosis after radical resection.However,the current prognostic model for pancreatic cancer based on TNM stage is not suitable for ASCP,and it is urgent to establish a prognostic model suitable for ASCP by combining with other clinical data.Therefore,this study was conducted to investigate the values of preoperative inflammatory-and immunerelated indicators[neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR),lymphocyte to monocyte ratio(LMR),and systemic immune-inflammatory index(SII)]in postoperative prognostic evaluation of ASCP,and establish a prognostic model for ASCP.Methods:Clinical data and follow-up records of 129 patients who underwent radical resection for ASCP in the Department of Hepatobiliary Pancreatic Surgery of Changhai Hospital Affiliated to the Naval Medical University of Chinese People’s Liberation Army from September 2012 to September 2019 were retrospectively analyzed.The cutoff values of NLR,PLR,LMR and SII were determined by the minimum P-value method.The differences in prognosis between patients grouped based on the cut-off value of each indicator were compared,and the differences in baseline characteristics between high SII group and low SII group were selectively compared.The prognostic factors for patients were determined by univariate analysis and multivariate Cox regression analysis,and then a prognostic index(PI)model for prognosis prediction was established.The abilities to predict two-year survival of patients of the PI prediction model and TNM stage prediction model were analyzed and compared by the receiver operating characteristic(ROC)curve.Results:The cutoff values of NLR,PLR,LMR and SII were 3.46,85.5,4.1 and 339.7,respectively.The differences in survival between patients grouped based on the cut-off value of each indicator were all statistically significant(all P<0.05).The proportions of cases with tumor located in th

关 键 词：胰腺肿瘤 腺鳞癌 系统免疫炎症指数 预后 

分 类 号：R736.7[医药卫生—肿瘤]