本文關(guān)鍵詞： 胰腺癌 吉西他濱 PLR NLR 預(yù)后因素　出處：《山東大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:多項(xiàng)研究表明,腫瘤微環(huán)境中的炎癥反應(yīng)在腫瘤的發(fā)生與進(jìn)展過(guò)程中發(fā)揮不可忽視的作用,全身炎癥反應(yīng)標(biāo)記物對(duì)多種腫瘤的預(yù)后具有預(yù)測(cè)作用。目前研究較多的炎癥反應(yīng)標(biāo)記物有外周血粒淋比(NLR),外周血血小板與淋巴細(xì)胞比值(PLR),外周血淋巴細(xì)胞與單核細(xì)胞比值(LMR)及預(yù)后營(yíng)養(yǎng)指數(shù)(PNI)等。然而目前尚未有研究報(bào)道炎癥反應(yīng)標(biāo)記物對(duì)于以吉西他濱為基礎(chǔ)方案化療的晚期胰腺癌病人的預(yù)后預(yù)測(cè)作用。本研究的目的即為探究治療前炎癥反應(yīng)標(biāo)記物對(duì)以吉西他濱為基礎(chǔ)方案化療的晚期胰腺癌病人的預(yù)后預(yù)測(cè)作用。方法:將2008年1月至2015年7月山東大學(xué)齊魯醫(yī)院收治的以吉西他濱為基礎(chǔ)方案化療的晚期胰腺癌患者53例納入研究,搜集患者臨床病例資料,并進(jìn)行回顧性分析。臨床病例資料包括患者的臨床特征及化療前各項(xiàng)血液學(xué)指標(biāo)。臨床特征包括患者性別,確診時(shí)年齡,吸煙史,嗜酒史,心血管疾病史,糖尿病史。血液學(xué)指標(biāo)包括淋巴細(xì)胞絕對(duì)值,中性粒細(xì)胞絕對(duì)值,單核細(xì)胞絕對(duì)值,血小板絕對(duì)值、白蛋白值、CEA值、CA-199值,通過(guò)計(jì)算得到NLR,PLR,LMR及PNI。利用 ROC 曲線確定 NLR、PLR、LMR、PNI 界值,分別為:3.675,176.62,2.815 和42.11。所有患者隨訪時(shí)間截止于2016年7月。使用Kaplan-Meier生存分析繪制生存曲線,采用log-rank檢驗(yàn)比較生存率,利用Cox比例風(fēng)險(xiǎn)回歸模型評(píng)估預(yù)后影響因素的風(fēng)險(xiǎn)比(HR)。結(jié)果:納入研究的53例患者的中位年齡為60歲,平均年齡(58.75±11.42)歲,其中男性患者32人,女性患者21人。中位生存時(shí)間為192天,所有患者的臨床分期均為Ⅳ期。53人均以吉西他濱為基礎(chǔ)方案化療,其中12人為吉西他濱單藥方案化療,26人為吉西他濱聯(lián)合氟尿嘧啶類藥物方案化療,15人為吉西他濱聯(lián)合鉑類藥物方案化療。53例患者中有16人有吸煙史,11人有嗜酒史,8人有糖尿病病史,4人有冠心病病史。Kaplan-Meier生存分析結(jié)果顯示,NLR3.675組患者與NLR≥3.675組患者相比具有更長(zhǎng)的生存時(shí)間(250天vs.192天,P=0.044,HR=0.500)。PLR176.62組患者比PLR≥176.62組患者具有更長(zhǎng)的生存時(shí)間(213 天 vs.168 天,P=0.025,HR=0.434).而 LMR(189 天 vs.201 天,P=0.350,HR=1.362)和 PNI(180 天 vs.201 天,P=0.250,HR=1.457)未顯示與納入患者的總生存率有明顯相關(guān)性。NLR升高與PLR升高均與有無(wú)吸煙史存在明顯相關(guān)性。Cox單變量分析結(jié)果顯示NLR升高(P=0.048,HR=0.523[95%CI,0.275~0.995])與 PLR 升高(P=0.012,HR=0.417[95%CI,0.211~0.824])均與較差的預(yù)后相關(guān),但Cox多變量分析結(jié)果顯示僅PLR升高與較差的預(yù)后相關(guān)(P=0.001,HR=0.107[95%CI,0.028~0.413]),而 NLR 未在 Cox 多變量分析中顯示有統(tǒng)計(jì)學(xué)差異(P=0.575,HR=0.727[95%CI,0.238~2.222])。結(jié)論:PLR是以吉西他濱為基礎(chǔ)方案化療的晚期胰腺癌病人的獨(dú)立的預(yù)后因素。PLR升高與較差的預(yù)后相關(guān)。本研究中NLR、LMR和PNI未顯示獨(dú)立預(yù)后預(yù)測(cè)作用。
[Abstract]:Objective: a number of studies have shown that inflammation in the tumor microenvironment play an important role in the occurrence and progression of tumor, play a role in predicting the prognosis of systemic inflammatory markers of tumors. The markers of inflammation are peripheral blood neutrophil lymphocyte ratio (NLR), peripheral blood platelet and lymphocyte ratio (PLR), peripheral blood lymphocytes and mononuclear cell ratio (LMR) and the prognostic nutritional index (PNI). Yet there is no role in predicting the prognosis of reported inflammatory markers for gemcitabine based chemotherapy for advanced pancreatic cancer patients. The aim of this study is to explore the treatment inflammatory markers for the prognosis of advanced pancreatic cancer patients with gemcitabine based chemotherapy for the predictive effect. Methods: from January 2008 to July 2015 in Qilu Hospital of Shandong University received treatment with gemcitabine Capecitabine based chemotherapy for 53 cases of advanced pancreatic cancer were included in the study, collect the clinical data of patients were retrospectively analyzed. The clinical data including clinical features and chemotherapy of patients with hematological indexes. The clinical features including gender, age at diagnosis, smoking history, drinking history, history of cardiovascular disease. A history of diabetes. Blood indexes including the absolute value of the absolute value of lymphocyte, neutrophil, monocyte absolute value, the absolute value of platelet, albumin value, CEA value, CA-199 value, NLR, LMR and PNI. calculated by PLR, using ROC curve to determine NLR, PLR, LMR, PNI, 3.675176.62,2.815 respectively. 42.11. and all patients were followed up at the end of July 2016. Using the Kaplan-Meier survival analysis draw survival curves, log-rank test was used to compare the survival rate, using Cox proportional hazards regression model to assess the prognosis for The risk ratio (HR). Results: the median age of the 53 cases of the patients enrolled in the study was 60 years old, the average age (58.75 + 11.42) years old, of which 32 were male, 21 female patients. The median survival time was 192 days, all patients were clinical stage IV to.53 per capita gemcitabine based chemotherapy, of which 12 were gemcitabine chemotherapy, 26 artificial gemcitabine combined with fluoropyrimidine chemotherapy, 15 human gemcitabine combined with platinum chemotherapy.53 patients, 16 had a history of smoking, 11 had a history of alcohol, 8 had a history of diabetes mellitus, 4 people a history of coronary heart disease.Kaplan-Meier survival analysis showed that compared with longer survival time of NLR3.675 group and NLR group were more than 3.675 (250 vs.192 days, P=0.044, HR=0.500) in.PLR176.62 group is longer than the PLR more than 176.62 groups of patients with survival time (213 days vs.168 Day, P=0.025, HR=0.434). LMR (189 vs.201 days, P=0.350, HR=1.362) and PNI (180 vs.201 days, P=0.250, HR=1.457) and did not show the total survival rate of patients with.NLR was correlated with increased smoking history there is obvious correlation between.Cox single variable analysis showed that the increase of NLR with the rise of PLR (P=0.048, HR=0.523[95%CI, 0.275~0.995]) and PLR (P=0.012, HR=0.417[95%CI, elevated 0.211~0.824]) were associated with worse prognosis, but Cox multivariate analysis showed that only PLR was associated with a poor prognosis (P=0.001, HR=0.107[95,%CI, 0.028~0.413], NLR) and not in the Cox multivariate analysis showed that there were significant differences (P=0.575, HR=0.727[95%CI, 0.238~2.222]). Conclusion: PLR is an independent prognostic factor for.PLR gemcitabine based chemotherapy for advanced pancreatic cancer patients. The prognosis was associated with worse. In this study, NLR, LMR and PN I did not demonstrate the prognostic role of independent prognosis.

【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735.9

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本文編號(hào)：1499981