發(fā)布時(shí)間：2018-06-20 17:15

  本文選題：胃癌 + 中性粒細(xì)胞與淋巴細(xì)胞比值��； 參考：《福建中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:研究胃癌患者術(shù)前中性粒細(xì)胞與淋巴細(xì)胞比值(Neutrophil-to-Lymphocyte Ratio,NLR)與腫瘤各預(yù)后因子之間的關(guān)系,探討胃癌患者術(shù)前NLR對(duì)預(yù)后轉(zhuǎn)歸的評(píng)估價(jià)值,進(jìn)而指導(dǎo)臨床治療。方法:選擇自2013年1月至2013年12月在莆田學(xué)院附屬醫(yī)院行胃癌根治術(shù)治療的122例患者病例資料進(jìn)行回顧性研究,其中男90例,女32例,平均年齡60.8歲。收集患者術(shù)前中性粒細(xì)胞計(jì)數(shù)、淋巴細(xì)胞計(jì)數(shù),根據(jù)所得數(shù)據(jù)計(jì)算患者NLR值。查閱大量海內(nèi)外文獻(xiàn)資料后,以NLR臨界值為2.5,將上述合格病例分為高NLR組和低NLR組,分析NLR值與患者年紀(jì)、性別、病理類(lèi)別、腫瘤大小、浸潤(rùn)深度、淋巴結(jié)轉(zhuǎn)移、TNM分期、HER-2基因等各因子之間的關(guān)系,并對(duì)患者術(shù)后進(jìn)行隨訪,評(píng)估NLR值對(duì)胃癌預(yù)后的臨床價(jià)值。結(jié)果:1.單因素分析術(shù)前NLR值與臨床各因子提示:術(shù)前NLR值高低與患者年紀(jì)、淋巴結(jié)轉(zhuǎn)移、腫瘤浸潤(rùn)深度、TNM分期及HER-2之間差別具有統(tǒng)計(jì)學(xué)定見(jiàn)(P0.05),NLR值越高,年紀(jì)越大、淋巴結(jié)擴(kuò)散的可能性越大、TNM分期越晚;HER-2陽(yáng)性患者NLR值較HER-2陰性患者高。而性別、病理類(lèi)別、腫瘤大小與NLR值之間無(wú)確切相關(guān)(P0.05)。進(jìn)一步Logisitic多因素回歸分析顯示:胃癌患者年紀(jì)、浸潤(rùn)深度、淋巴結(jié)轉(zhuǎn)移、TNM分期、HER-2與術(shù)前NLR值密切關(guān)聯(lián)(P0.05)。2.腫瘤浸潤(rùn)深度、TNM分期、淋巴結(jié)擴(kuò)散、HER-2、術(shù)前NLR值對(duì)患者術(shù)后轉(zhuǎn)歸有重要定見(jiàn)(P0.05),年紀(jì)、性別、腫瘤大小、病理分化類(lèi)別與患者術(shù)后轉(zhuǎn)歸無(wú)確切關(guān)聯(lián)(P0.05)。低NLR組患者3年存活率明顯優(yōu)于高NLR組病人(P=0.011),HER-2陰性患者預(yù)后好于HER-2陽(yáng)性患者(P=0.02);腫瘤浸潤(rùn)深度越深(P=0.000)、TNM分期越晚(P=0.000)、淋巴結(jié)轉(zhuǎn)移越多(P=0.006),患者3年生存率越低。結(jié)論:1.術(shù)前NLR水平可能與年紀(jì)、淋巴結(jié)擴(kuò)散、腫瘤浸潤(rùn)深度、TNM分期及HER-2緊密相關(guān)。2.術(shù)前NLR、腫瘤浸潤(rùn)深度、TNM分期、淋巴結(jié)擴(kuò)散可能對(duì)患者預(yù)后有重要意義。3.術(shù)前NLR或許可以成為胃癌轉(zhuǎn)歸的一種簡(jiǎn)便有用的評(píng)估標(biāo)志物。
[Abstract]:Objective: to study the relationship between neutrophil-to-Lymphocyte Ratiophocyte NLR- (NLR-) and tumor prognostic factors in patients with gastric cancer before operation, and to explore the value of preoperative NLR in evaluating prognosis and prognosis in patients with gastric cancer, so as to guide clinical treatment. Methods: from January 2013 to December 2013, 122 patients with gastric cancer treated by radical gastrectomy in Putian University Hospital were retrospectively studied, including 90 males and 32 females, with an average age of 60.8 years. Neutrophil count and lymphocyte count were collected and NLR values were calculated. According to the critical value of NLR was 2.5, the patients were divided into high NLR group and low NLR group. The NLR value and age, sex, pathological type, tumor size, depth of invasion were analyzed. The relationship between HER-2 gene and TNM staging of lymph node metastasis was evaluated. The clinical value of NLR in the prognosis of gastric cancer was evaluated. The result is 1: 1. Univariate analysis of preoperative NLR values and clinical factors suggested that preoperative NLR values were significantly different between preoperative NLR values and patient age, lymph node metastasis, TNM stage of tumor invasion depth and HER-2. The higher the NLR value was, the higher the NLR value was and the older the patient was. The higher the probability of lymph node diffusion, the higher the NLR value in HER-2 positive patients with TNM stage. However, there was no positive correlation between sex, pathological type, tumor size and NLR value (P 0.05). Further Logisitic multivariate regression analysis showed that age, depth of invasion, lymph node metastasis, TNM staging and HER-2 were closely correlated with preoperative NLR value (P0.05. 2). TNM stage, lymph node diffusion (HER-2), preoperative NLR value were important for postoperative outcome (P0.05), age, sex, tumor size, pathological differentiation type had no definite correlation with postoperative outcome (P0.05). The 3-year survival rate of low NLR group was significantly better than that of HER-2 negative patients with high NLR, and the deeper the depth of tumor invasion was, the later the TNM stage was, the more lymph node metastasis was, the lower the 3-year survival rate was. Conclusion 1. Preoperative NLR levels may be closely related to age, lymph node diffusion, depth of tumor invasion, TNM stage and HER-2. Preoperative NLR, depth of tumor invasion and TNM stage, lymph node diffusion may have important significance for prognosis of patients. Preoperative NLR may be a simple and useful marker for evaluating the outcome of gastric cancer.
【學(xué)位授予單位】：福建中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R735.2

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本文編號(hào)：2045023