γ-谷氨酰转肽酶/血小板计数比值对接受一线化疗方案的Ⅲ-Ⅳ期胃癌患者的预后价值  

Prognostic value ofγ-glutamyl transpeptidase to platelet ratio index(GPRI)ratio in patients with stageⅢ-Ⅳgastric cancer receiving first-line chemotherapy

作　　者：胡咏[1] 黄士月 张天丹 陈涛[2] 罗阳超 HU Yong;HUANG Shiyue;ZHANG Tiandan;CHEN Tao;LUO Yangchao(Department of Pathology,Chengdu Xindu District People′s Hospital,Chengdu 610500,China;Department of Laboratory,Chengdu Xindu District People′s Hospital,Chengdu 610500,China;Department of Oncology,Chengdu Xindu District People′s Hospital,Chengdu 610500,China)

机构地区：[1]成都市新都区人民医院病理科,成都610500 [2]成都市新都区人民医院检验科,成都610500 [3]成都市新都区人民医院肿瘤科,成都610500

出　　处：《新疆医科大学学报》2023年第8期1021-1027,共7页Journal of Xinjiang Medical University

基　　金：四川省科技计划项目(1FZ0077)。

摘　　要：目的 探讨γ-谷氨酰转肽酶(γ-gamma-glutamyl transpeptidase, GGT)/血小板计数(Platelet, PLT)比值(γ-glutamyl transpeptidase to platelet ratio index, GPRI)对接受一线化疗方案的Ⅲ-Ⅳ期胃癌患者预后的预测价值。方法 选择138例非手术治疗的Ⅲ-Ⅳ期胃癌患者为研究对象,采集患者化疗前外周静脉血,检测GGT水平及PLT,根据公式GPRI=GGT/PLT(×109/L),计算不同患者的GPRI值。以GPRI>0.39为界值,将患者分为高GPRI组及低GPRI组。对患者进行连续性随访,采用卡方检验分析患者临床病理参数对GPRI比值的影响;利用Kaplan-Meier法及Log-rank检验分析GPRI比值对患者预后的影响。结果 (1)受试者工作特征(Receiver operating characteristic,ROC)曲线分析显示,GPRI、GGT、PLT的最佳临界值分别为0.39、64.68和178.59,ROC曲线下面积(Area under curve,AUC)分别为0.776、0.659和0.705,GPRI判断患者预后的效能明显优于单独检测GGT和血小板。(2)与低GPRI组相比,高GPRI组患者中>1器官转移及腹膜转移发生率、Ⅳ期患者比例、糖苷类肿瘤标志物(CA19-9)>37 U/mL的患者比例均明显较高(P<0.05)。且>1个器官转移(P=0.002)、腹膜转移(P=0.024)、Ⅳ期(P=0.008)、CA19-9水平(P=0.004)和GPRI>0.39(P=0.033)均是影响患者中位无进展生存期(Progression free survival, PFS)和中位总生存期(Overall survival, OS)的独立性危险因素。(3)所有患者的OS及PFS分别为156 d和217 d。低GPRI组、高GPRI组患者的中位PFS分别为202 d、117 d;中位OS分别为269 d、173 d,差异均有统计学意义(P均<0.05)。进一步行亚组分析发现,在转移器官>1个(χ^(2)=18.24,P<0.01)、Ⅳ期(χ^(2)=19.85,P<0.01)和CA19-9水平升高(χ^(2)=12.65,P<0.01)的亚组患者中,低GPRI组患者的OS均明显好于高GPRI组。结论 GPRI对接受一线化疗方案的Ⅲ-Ⅳ期胃癌患者的预后有较高的预测价值,有望作为晚期胃癌患者的一项新的预后指标。Objective To investigate the prognostic value ofγ-glutamyl transpeptidase(GGT)/platelet(PLT)count ratio(GPRI)in patients with stageⅢ-Ⅳgastric cancer receiving first-line chemotherapy.Methods138 non-surgical stageⅢ-Ⅳgastric cancer patients were selected as the study subjects.Peripheral venous blood was collected from patients before the chemotherapy,and GGT levels and PLT were measured.According to the formula GPRI=GGT/PLT(×10\+9/L),to calculate the GPRI values for the different patients.Divided the patients into high GPRI group and low GPRI group with GPRI>0.39 as the cutoff value.The patients were followed up continuously,and the influence of clinical and pathological parameters on GPRI ratio were analyzed by Chi-squared test.Analyzed the impact of GPRI ratio on patient prognosis with using Kaplan Meier method and Log rank test.Results(1)The receiver operating characteristic(ROC)curve analysis showed that the optimal critical values of GPRI,GGT and PLT were 0.39,64.68 and 178.59,respectively,and the area under the receiver operating characteristic was 0.776,0.659 and 0.705,respectively.GPRI was significantly better than GGT and platelet alone in judging the prognosis of the patients.(2)Compared with the low GPRI group,the incidence of>1 organ metastasis and peritoneal metastasis,the proportion of stageⅣpatients,and the proportion of the patients with CA19-9>37 U/mL were significantly higher in the high GPRI group(P<0.05).And>1 organ metastasis(P=0.002),peritoneal metastasis(P=0.024),stageⅣ(P=0.008),CA19-9 level(P=0.004),and GPRI>0.39(P=0.033)were independent risk factors affecting patient OS and PFS.(3)The median progression free survival(PFS)and median overall survival(OS)of all the patients were 156 days and 217 days,respectively.The median PFS of the patients in low GPRI group and high GPRI group were 202 days and 117 days,respectively.The median OS was 269 days and 173 days,respectively,with statistically significant differences(P<0.05).Further subgroup analysis revealed that in metastatic orga

关 键 词：胃癌 Γ-谷氨酰转肽酶 血小板计数 一线化疗 晚期肿瘤 

分 类 号：R735.2[医药卫生—肿瘤]