發(fā)布時(shí)間：2018-04-22 12:40

  本文選題：胃癌 + 淋巴結(jié)轉(zhuǎn)移��； 參考：《山西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:本研究旨在探索術(shù)前中性粒細(xì)胞-淋巴細(xì)胞比值(NLR)及血小板-淋巴細(xì)胞比值(PLR)與胃癌病理特征及淋巴結(jié)轉(zhuǎn)移的相關(guān)性,并分析其在淋巴結(jié)轉(zhuǎn)移評(píng)估中的意義。方法:采用回顧性病例對(duì)照研究方法。收集2014年6月至2016年12月于山西省人民醫(yī)院普通外科接受手術(shù)的150例原發(fā)胃癌患者的資料�；举Y料:性別、年齡;術(shù)前外周血指標(biāo)包括中性粒細(xì)胞數(shù)(NEU)、淋巴細(xì)胞數(shù)(LYM)、血小板計(jì)數(shù)(PLT)、并計(jì)算其比值NLR(中性粒細(xì)胞-淋巴細(xì)胞數(shù)之比)、PLR(血小板-淋巴細(xì)胞數(shù)之比);病理學(xué)指標(biāo):腫瘤位置(賁門(mén)胃底、胃體、胃竇)、大小、浸潤(rùn)深度(T1-T2、T3-T4)、組織學(xué)類(lèi)型(腺癌、印戒細(xì)胞癌、粘液腺癌等)、分化程度(低、中-高分化)、區(qū)域淋巴結(jié)轉(zhuǎn)移情況,腫瘤TNM分期。首先用ROC曲線(xiàn)評(píng)估術(shù)前NLR、PLR的臨床效用,確定最佳截值并分高、低組,比較兩者與病例特征的相關(guān)性。然后分析與淋巴結(jié)轉(zhuǎn)移相關(guān)的單因素,在此基礎(chǔ)上進(jìn)行l(wèi)ogistic回歸分析,確定影響淋巴結(jié)轉(zhuǎn)移的獨(dú)立因素,并初步分析NLR、PLR在胃癌淋巴結(jié)轉(zhuǎn)移中的意義。結(jié)果:納入本研究的150例原發(fā)胃癌患者中,男性98例(65.33%),女性52例(34.67%),平均年齡為59.84±10.66歲(范圍31-84歲),癌腫直徑平均值為3.98±1.46cm。賁門(mén)胃底癌43例(28.67%),胃體癌39例(26%),胃竇癌68例(45.33%)。病檢顯示:136例(90.67%)為腺癌,14例(9.33%)為印戒細(xì)胞癌、粘液腺癌、腺鱗癌及其他類(lèi)型;低分化113例(75.33%),術(shù)后分期:Ⅰ-Ⅱ期患者44例(29.33%),Ⅲ-Ⅳ期患者106例(70.67%)。分析結(jié)果顯示,術(shù)前NLR、PLR與性別、腫瘤位置、組織學(xué)類(lèi)型、分化程度無(wú)關(guān)(P0.05),高NLR患者年齡大、腫瘤大、浸潤(rùn)深、淋巴結(jié)轉(zhuǎn)移率及TNM分期更高(P0.05),PLR也隨著年齡、癌腫的增大及腫瘤的進(jìn)展明顯增高(P0.05)。本組患者平均淋巴結(jié)轉(zhuǎn)移率為68.0%,單因素分析表明:癌腫大小、分化程度、浸潤(rùn)深度、NLR、PLR均與淋巴結(jié)轉(zhuǎn)移相關(guān)(P0.05),且淋巴結(jié)轉(zhuǎn)移陽(yáng)性者NLR、PLR明顯增高。多因素分析顯示,腫瘤大小、浸潤(rùn)深度、分化程度是胃癌淋巴結(jié)轉(zhuǎn)移的獨(dú)立危險(xiǎn)因素。術(shù)前NLR及PLR對(duì)胃癌淋巴結(jié)轉(zhuǎn)移的評(píng)估有一定的參考價(jià)值。結(jié)論:在胃癌中,術(shù)前NLR、PLR是與癌腫大小、浸潤(rùn)深度、淋巴結(jié)轉(zhuǎn)移及TNM分期相關(guān)聯(lián)的生物學(xué)指標(biāo),癌腫大小、浸潤(rùn)深度、分化程度是胃癌淋巴結(jié)轉(zhuǎn)移的獨(dú)立危險(xiǎn)因素,NLR、PLR對(duì)術(shù)前淋巴結(jié)轉(zhuǎn)移的評(píng)估及術(shù)中清掃中可能有一定的價(jià)值。
[Abstract]:Objective: to investigate the relationship between preoperative neutrophil / lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) and the pathological features and lymph node metastasis of gastric cancer, and to analyze its significance in the evaluation of lymph node metastasis. Methods: a retrospective case-control study was conducted. From June 2014 to December 2016, 150 patients with primary gastric cancer who underwent surgery in general surgery of Shanxi Provincial people's Hospital were collected. Basic information: sex, age; Preoperative peripheral blood parameters included neutrophils, lymphocyte count, platelet count and platelet count, and calculated the ratio of neutrophil to lymphocyte number and the ratio of neutrophil to lymphocyte; pathological parameters: tumor location (the fundus of cardia and stomach), the ratio of neutrophil to lymphocyte and the ratio of neutrophil to lymphocyte. Gastric body, antrum, size, depth of invasion, histological type (adenocarcinoma, signet ring cell carcinoma, mucinous adenocarcinoma, etc.), differentiation degree (low, medium-high differentiation, regional lymph node metastasis, TNM stage of the tumor). The ROC curve was used to evaluate the clinical efficacy of NLRL PLR before operation, and the optimal cut-off value was determined and divided into high and low groups, and the correlation between the two groups and the characteristics of the cases was compared. Based on the analysis of the single factor associated with lymph node metastasis, logistic regression analysis was carried out to determine the independent factors affecting lymph node metastasis, and the significance of NLR-PLR in lymph node metastasis of gastric cancer was preliminarily analyzed. Results: of the 150 patients with primary gastric cancer, 98 were male and 52 were female, with an average age of 59.84 鹵10.66 years (range 31-84 years, mean diameter of cancer 3.98 鹵1.46 cm). There were 43 cases of gastric fundus carcinoma, 39 cases of gastric body carcinoma and 68 cases of antral carcinoma. The pathological examination showed that 14 cases (9. 33%) were adenocarcinomas, including signet ring cell carcinoma, mucinous adenocarcinoma, adenosquamous carcinoma and other types, and 113 cases with low differentiation (75.33%) and 44 cases with stage 鈪，

本文編號(hào)：1787258