多种免疫炎症指标对肝内胆管癌患者根治性切除术后预后的预测价值  

Prognostic value of several immune and inflammatory indices after curative-intent resection for intrahepatic cholangiocarcinoma

作　　者：马炳奇[1] 孟慧娟[2] 张伟[3] 董小锋[4] 王蒙[1] 窦杰 吴雨宁 李世平[1] MA Bingqi;MENG Huijuan;ZHANG Wei;DONG Xiaofeng;WANG Meng;DOU Jie;WU Yuning;LI Shiping(Department of Hepatopancreatobiliary Surgery,Affiliated Hospital of Weifang Medical University,Weifang,Shandong 261031,China;Department of Dermatology,Affiliated Hospital of Weifang Medical University,Weifang,Shandong 261031,China;Department of Hepatobiliary Surgery,Tianjin Medical University Cancer Institute and Hospital,Tianjin 300060,China;Department of Hepatobiliary,Pancreatic and Splenic Surgery,The People’s Hospital of Guangxi Zhuang Autonomous Region&Guangxi Academy of Medical Sciences,Nanning 530021,China)

机构地区：[1]潍坊医学院附属医院肝胆胰外科,山东潍坊261031 [2]潍坊医学院附属医院皮肤科,山东潍坊261031 [3]天津医科大学肿瘤医院肝胆肿瘤科,天津300060 [4]广西壮族自治区人民医院(广西医学科学院)肝胆胰脾外科,南宁530021

出　　处：《临床肝胆病杂志》2022年第9期2061-2066,共6页Journal of Clinical Hepatology

基　　金：山东省医药卫生科技发展计划项目(202004011537);潍坊市科学技术发展计划(医学类)(2020YX085);医学科研发展基金项目-临床与基础研究专项(TB205004)。

摘　　要：目的探讨不同的免疫炎症指标对肝内胆管癌(ICC)患者行根治切除术后生存结局预测价值的差异。方法回顾性收集2012年1月—2017年12月于潍坊医学院附属医院和天津医科大学肿瘤医院接受根治性切除术的122例ICC患者的病例资料,分析免疫炎症指标中性粒细胞/淋巴细胞比率(NLR)、淋巴细胞/单核细胞比值(LMR)、系统免疫炎症指数(SII)、炎症预后指标(PII)、炎症评分(IS)和系统炎症评分(SIS)与ICC患者术后无瘤生存期(DFS)和总生存期(OS)的相关性,评估上述指标的预后预测价值。计数资料组间比较采用χ^(2)检验或Fisher精确概率法。Kaplan-Meier法绘制生存曲线,组间差异比较采用Log-rank检验;采用Cox回归模型进行单因素和多因素分析,并计算风险比(HR)及95%CI。结果单因素生存分析结果显示,NLR、LMR、PII、PNI、IS、SII和SIS是ICC患者术后DFS的预测因素(HR值分别为2.212、0.403、3.013、0.530、1.809、2.107和2.225,P值分别为0.004、0.012、<0.001、0.019、0.001、0.002和<0.001);NLR、LMR、PII、PNI、IS、SII和SIS是患者术后OS的预测因素(HR值分别为2.416、0.297、3.288、0.292、2.048、1.839和2.335,P值分别为0.009、0.008、<0.001、0.003、0.002、0.049和<0.001)。多因素生存分析结果显示,高水平PII、SIS是ICC患者术后DFS的独立影响因素(HR值分别为2.146、2.511,P值分别为0.035、<0.001);高水平PII、PNI、SIS是患者术后OS的独立影响因素(HR值分别为2.981、0.261、2.294,P值分别为0.009、0.002、0.010);高水平PII组ICC患者肿瘤学T分期(χ^(2)=8.777,P=0.003)和M分期(P=0.029)更晚;高级别的SIS组患者肿瘤学N分期(χ^(2)=9.985,P=0.030)和M分期(χ^(2)=8.574,P=0.012)更晚。结论在现行的多种炎症指标中,PII和SIS更适用于术前对ICC患者行根治性切除术疗效分层的预测评估。Objective To investigate the value of different immune and inflammatory indices in predicting the survival outcome of patients with intrahepatic cholangiocarcinoma(ICC)after curative-intent resection.Methods A retrospective analysis was performed for the case data of 122 patients with ICC who underwent curative-intent resection in Affiliated Hospital of Weifang Medical University and Tianjin Medical University Cancer Institute and Hospital from January 2012 to December 2017 to analyze the correlation of neutrophil-lymphocyte ratio(NLR),lymphocyte-monocyte ratio(LMR),systemic immune-inflammation index(SII),prognostic inflammation index(PII),inflammation score(IS),and systemic inflammation score(SIS)with the disease-free survival(DFS)and overall survival of ICC patients after surgery,and the value of the above indices in predicting prognosis was evaluated.The chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups.The Kaplan-Meier method was used to plot survival curves,and the Log-rank test was used for comparison between groups;the Cox regression model was used for univariate and multivariate analyses,and hazard ratio(HR)and 95% confidence interval[CI]were calculated.Results The univariate survival analysis showed that NLR(HR=2.212,P=0.004),LMR(HR=0.403,P=0.012),PII(HR=3.013,P<0.001),prognostic nutritional index(PNI)(HR=0.530,P=0.019),IS(HR=1.809,P=0.001),SII(HR=2.107,P=0.002),and SIS(HR=2.225,P<0.001)were predictive factors for postoperative DFS of patients with ICC,and NLR(HR=2.416,P=0.009),LMR(HR=0.297,P=0.008),PII(HR=3.288,P<0.001),PNI(HR=0.292,P=0.003),IS(HR=2.048,P=0.002),SII(HR=1.839,P=0.049),and SIS(HR=2.335,P<0.001)were predictive factors for postoperative OS of patients with ICC.The multivariate survival analysis showed that high levels of PII(HR=2.146,P=0.035)and SIS(HR=2.511,P<0.001)were independent influencing factors for postoperative DFS of ICC patients,and high levels of PII(HR=2.981,P=0.009),PNI(HR=0.261,P=0.002),and SIS(HR=2.294,P=0.010)were indepe

关 键 词：胆管肿瘤 胆管 肝内 预后 预测 

分 类 号：R735.8[医药卫生—肿瘤]