外周血中性粒細(xì)胞與淋巴細(xì)胞比值變化對胃癌患者預(yù)后的影響
發(fā)布時間：2018-11-07 16:28
【摘要】：研究背景胃癌是全球排名第二的癌癥相關(guān)的死亡原因,盡管近年來其發(fā)病率有下降趨勢,但每年仍導(dǎo)致750,000人死亡。炎癥與胃癌之間有著緊密的聯(lián)系,深入學(xué)習(xí)并研究炎癥在胃癌中的分子生物學(xué)機(jī)制,能為胃癌的治療提供新的策略。目的外周血中性粒細(xì)胞與淋巴細(xì)胞的比值(NLR)是反應(yīng)機(jī)體炎癥的重要血清標(biāo)志,大量研究成果顯示,NLR升高與胃癌患者的低生存率具有相關(guān)性。NLR升高提示胃癌患者預(yù)后較差。以往研究只關(guān)注于胃癌患者接受治療之前的NLR水平,而對于術(shù)后NLR與胃癌患者預(yù)后的相關(guān)性卻鮮有報道。NLR是一個動態(tài)變化的過程,術(shù)前與術(shù)后NLR的變化,從側(cè)面反映出機(jī)體內(nèi)免疫功能的變化。而且目前的臨床研究并未就NLR水平高低的臨界值達(dá)成統(tǒng)一。本文通過回顧性分析275例胃癌患者臨床病理特點(diǎn),探討NLR變化與胃癌患者預(yù)后之間的關(guān)系。方法回顧性分析2010年5月至2011年12月間于山東大學(xué)齊魯醫(yī)院普外科接受治療的275例胃癌患者,隨訪記錄獲得臨床病理資料和預(yù)后信息。采用IBM SPSS Statistics 軟件(version 22.0;SPSS,Inc.,Chicago,IL,USA)行統(tǒng)計學(xué)分析。X2檢驗(yàn)應(yīng)用于比較分類變量,獨(dú)立樣本的t檢驗(yàn)應(yīng)用于連續(xù)變量的比較�？偵嫫�(OS)和無復(fù)發(fā)生存期(RFS)用Kaplan-Meier法計算并用log-rank檢驗(yàn)法進(jìn)行分析。采用Kaplan-Meier生存曲線單因素分析患者年齡、性別、腫瘤位置、分化程度、腫瘤直徑、陽性淋巴結(jié)比例、腫瘤侵襲深度、淋巴結(jié)轉(zhuǎn)移數(shù)目、有無癌栓、術(shù)前CEA、術(shù)前CA19-9、術(shù)后是否接受化療與患者RFS及OS的關(guān)系。利用COX比例風(fēng)險回歸多因素分析臨床病理資料與OS和RFS的關(guān)系。P0.05表示差異有統(tǒng)計學(xué)意義。結(jié)果:共收集275例于齊魯醫(yī)院接受手術(shù)治療的胃癌患者的臨床資料,其中男性202例,女性73例。根據(jù)術(shù)前及術(shù)后患者NLR比值變化,將其分為兩組:NLR升高組,NLR降低組。兩組患者年齡、性別、腫瘤位置、分化程度、腫瘤直徑、陽性淋巴結(jié)比例、腫瘤侵襲深度、淋巴結(jié)轉(zhuǎn)移數(shù)目、有無癌栓、術(shù)前CEA、術(shù)前CA19-9、術(shù)后是否接受化療等臨床病理資料間差異無統(tǒng)計學(xué)意義。對于術(shù)后NLR升高的患者,其1、3、5年RFS分別為64.2%,23.2%,15.8%;對于術(shù)后NLR降低的患者,其1、3、5年RFS分別為73.9%,49.9%,47.0%。,差異有統(tǒng)計學(xué)意義(P0.001)。對于術(shù)后NLR升高的患者,其1、3、5年OS分別為81.1%,34.7%,15.8%;對于術(shù)后NLR降低的患者,其1、3、5年OS分別為88.3%,57.8%,47.1%,差異有統(tǒng)計學(xué)意義(P,0.001)。單因素分析結(jié)果顯示患者腫瘤直徑、淋巴結(jié)陽性比率、淋巴結(jié)陽性數(shù)目、癌栓、術(shù)前血清CEA、術(shù)前血清CA19-9、術(shù)后NLR變化以及術(shù)后化療與胃癌預(yù)后相關(guān)。多因素分析結(jié)果顯示,術(shù)后NLR變化,腫瘤直徑,淋巴結(jié)陽性比率,術(shù)后化療是胃癌患者預(yù)后的獨(dú)立影響因素。結(jié)論術(shù)后NLR變化是影響胃癌患者預(yù)后的獨(dú)立因素。無論術(shù)前NLR水平高或低,對于術(shù)后NLR升高的患者,其預(yù)后要比術(shù)后NLR減低的患者更差。
[Abstract]:Background gastric cancer is the world's second leading cause of cancer-related deaths, accounting for 750000 deaths a year, despite a downward trend in recent years. There is a close relationship between inflammation and gastric cancer. Studying and studying the molecular biological mechanism of inflammation in gastric cancer can provide a new strategy for the treatment of gastric cancer. Objective the ratio of peripheral blood neutrophils to lymphocytes (NLR) is an important serum marker of inflammation. The increase of NLR was correlated with the low survival rate of gastric cancer patients, and the increase of NLR suggested that the prognosis of gastric cancer patients was poor. Previous studies only focused on NLR levels in patients with gastric cancer before treatment, but the correlation between postoperative NLR and prognosis of gastric cancer patients was rarely reported. NLR is a dynamic process, and the changes of NLR before and after operation. The changes of immune function in the body are reflected from the side. Moreover, the current clinical studies have not unified the critical value of NLR level. The clinicopathological features of 275 patients with gastric cancer were retrospectively analyzed to explore the relationship between the changes of NLR and the prognosis of gastric cancer patients. Methods 275 patients with gastric cancer received general surgery from May 2010 to December 2011 in Qilu Hospital of Shandong University were retrospectively analyzed. The clinicopathological data and prognostic information were obtained. The statistical analysis was carried out by using IBM SPSS Statistics software (version 22.0 / SPSSc.Chicagoil USA). The X2 test was applied to compare the classified variables, and the t-test of independent samples was applied to the comparison of continuous variables. Total survival time (OS) and recurrence free survival (RFS) were calculated by Kaplan-Meier method and analyzed by log-rank test. Age, sex, tumor location, differentiation degree, tumor diameter, positive lymph node ratio, depth of tumor invasion, number of lymph node metastasis, tumor thrombus, preoperative CA19-9, before CEA, were analyzed by single factor analysis of Kaplan-Meier survival curve. The relationship between chemotherapy and RFS and OS after operation. COX proportional risk regression was used to analyze the relationship between clinicopathological data and OS and RFS. Results: a total of 275 patients with gastric cancer underwent surgical treatment in Qilu Hospital were collected, including 202 males and 73 females. According to the changes of NLR ratio before and after operation, the patients were divided into two groups: NLR increased group and NLR decreased group. Age, sex, tumor location, degree of differentiation, diameter of tumor, proportion of positive lymph nodes, depth of invasion, number of lymph node metastasis, tumor thrombus, preoperative CA19-9, before CEA, There was no significant difference in clinical and pathological data such as chemotherapy after operation. For the patients with elevated NLR after operation, the RFS of 1 and 5 years were 64.2 and 23.2and 15.8respectively. For the patients with lower NLR after operation, the RFS in 1 and 5 years were 73.9 and 47.9, respectively. The difference was statistically significant (P0.001). For the patients with elevated NLR after operation, the OS of 1 and 5 years were 81.1 and 34.7, respectively. For the patients with lower NLR after operation, the OS in 1 and 5 years were 88.3and 57.8, respectively. The difference was statistically significant (P0. 001). Univariate analysis showed that tumor diameter, lymph node positive ratio, number of lymph nodes positive, tumor thrombus, serum CA19-9, before and after operation of CEA, and postoperative chemotherapy were correlated with prognosis of gastric cancer. Multivariate analysis showed that postoperative NLR, tumor diameter, lymph node positive ratio and postoperative chemotherapy were independent prognostic factors in patients with gastric cancer. Conclusion postoperative NLR is an independent factor for the prognosis of gastric cancer patients. Whether the preoperative NLR level was high or low, the prognosis of patients with elevated NLR was worse than that of patients with lower NLR.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R735.2
本文編號：2316908
[Abstract]:Background gastric cancer is the world's second leading cause of cancer-related deaths, accounting for 750000 deaths a year, despite a downward trend in recent years. There is a close relationship between inflammation and gastric cancer. Studying and studying the molecular biological mechanism of inflammation in gastric cancer can provide a new strategy for the treatment of gastric cancer. Objective the ratio of peripheral blood neutrophils to lymphocytes (NLR) is an important serum marker of inflammation. The increase of NLR was correlated with the low survival rate of gastric cancer patients, and the increase of NLR suggested that the prognosis of gastric cancer patients was poor. Previous studies only focused on NLR levels in patients with gastric cancer before treatment, but the correlation between postoperative NLR and prognosis of gastric cancer patients was rarely reported. NLR is a dynamic process, and the changes of NLR before and after operation. The changes of immune function in the body are reflected from the side. Moreover, the current clinical studies have not unified the critical value of NLR level. The clinicopathological features of 275 patients with gastric cancer were retrospectively analyzed to explore the relationship between the changes of NLR and the prognosis of gastric cancer patients. Methods 275 patients with gastric cancer received general surgery from May 2010 to December 2011 in Qilu Hospital of Shandong University were retrospectively analyzed. The clinicopathological data and prognostic information were obtained. The statistical analysis was carried out by using IBM SPSS Statistics software (version 22.0 / SPSSc.Chicagoil USA). The X2 test was applied to compare the classified variables, and the t-test of independent samples was applied to the comparison of continuous variables. Total survival time (OS) and recurrence free survival (RFS) were calculated by Kaplan-Meier method and analyzed by log-rank test. Age, sex, tumor location, differentiation degree, tumor diameter, positive lymph node ratio, depth of tumor invasion, number of lymph node metastasis, tumor thrombus, preoperative CA19-9, before CEA, were analyzed by single factor analysis of Kaplan-Meier survival curve. The relationship between chemotherapy and RFS and OS after operation. COX proportional risk regression was used to analyze the relationship between clinicopathological data and OS and RFS. Results: a total of 275 patients with gastric cancer underwent surgical treatment in Qilu Hospital were collected, including 202 males and 73 females. According to the changes of NLR ratio before and after operation, the patients were divided into two groups: NLR increased group and NLR decreased group. Age, sex, tumor location, degree of differentiation, diameter of tumor, proportion of positive lymph nodes, depth of invasion, number of lymph node metastasis, tumor thrombus, preoperative CA19-9, before CEA, There was no significant difference in clinical and pathological data such as chemotherapy after operation. For the patients with elevated NLR after operation, the RFS of 1 and 5 years were 64.2 and 23.2and 15.8respectively. For the patients with lower NLR after operation, the RFS in 1 and 5 years were 73.9 and 47.9, respectively. The difference was statistically significant (P0.001). For the patients with elevated NLR after operation, the OS of 1 and 5 years were 81.1 and 34.7, respectively. For the patients with lower NLR after operation, the OS in 1 and 5 years were 88.3and 57.8, respectively. The difference was statistically significant (P0. 001). Univariate analysis showed that tumor diameter, lymph node positive ratio, number of lymph nodes positive, tumor thrombus, serum CA19-9, before and after operation of CEA, and postoperative chemotherapy were correlated with prognosis of gastric cancer. Multivariate analysis showed that postoperative NLR, tumor diameter, lymph node positive ratio and postoperative chemotherapy were independent prognostic factors in patients with gastric cancer. Conclusion postoperative NLR is an independent factor for the prognosis of gastric cancer patients. Whether the preoperative NLR level was high or low, the prognosis of patients with elevated NLR was worse than that of patients with lower NLR.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R735.2
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，本文編號：2316908
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