全身免疫炎症指数(SII)与胃癌患者临床病理因素及预后的相关性

Relationship between systemic immune-inflammatory index(SII)and clinical pathological features and prognosis in patients with gastric cancer

目的:探讨术前全身免疫炎症指数(SII)与胃癌患者临床病理因素及预后的相关性。方法:回顾性分析2010年1月至2013年12月哈尔滨医科大学附属肿瘤医院胃肠外科行根治性手术治疗的823例患者的临床病理资料,根据术前化验结果计算出SII值(SII=血小板×中性粒细胞/淋巴细胞),采用ROC曲线截取最佳临界值。将SII分为高低两组,分析SII与患者临床病理因素之间的关系,Kaplan-Meier法绘制生存曲线,Log-rank法进行单因素分析,COX回归风险模型进行多因素分析。结果:最佳SII截取值为427.3,SII≤427.3组有459例,SII>427.3组有364例。SII与患者的年龄、肿瘤浸润深度、淋巴结转移数目、肿瘤TNM分期、白蛋白、前白蛋白、白球比、癌胚抗原(CEA)水平均有关(均P<0.05)。截止到2018年3月存活514例,死亡309例,SII≤427.3组患者总体生存期(OS)明显优于SII>427.3组患者,差异具有统计学意义(P=0.000)。单因素分析结果显示,年龄、肿瘤位置、组织分化程度、肿瘤浸润深度、淋巴结转移数目、肿瘤TNM分期、白蛋白、前白蛋白、白球比、CEA、糖类抗原199(CA-199)及SII与行根治性手术胃癌患者的预后相关(P均<0.05)。多因素分析结果显示,年龄(HR=1.487,95%CI=1.162~1.902,P=0.020)、肿瘤位置(HR=0.696,95%CI=0.597~0.811,P=0.000)、肿瘤浸润深度(HR=2.241,95%CI=1.184~4.244,P=0.013)、淋巴结转移数目(HR=1.337,95%CI=1.121~1.595,P=0.001)、肿瘤TNM分期(HR=1.289, 95%CI=1.067~1.558,P=0.008)、前白蛋白(HR=0.720,95%CI=0.560~0.926,P=0.010)、CA-199(HR=1.513,95%CI=1.204~1.901,P=0.000)、SII(HR=1.577,95%CI=1.253~1.984,P=0.000)是影响根治性胃癌手术患者预后的独立危险因素。结论:对于行根治性手术的胃癌患者SII是一种可靠的预测预后的指标,术前高的SII值预示着差的预后。

Objective:To investigate the relationship between preoperative systemic immune-inflammation index(SII)and clinical pathological features and prognosis in patients with gastric cancer.Methods:The clinical and pathological data of 823 patients undergoing radical surgery for gastrointestinal surgery at the Affiliated Tumor Hospital of Harbin University from January 2010 to December 2013 were retrospectively analyzed.SII was calculated based on preoperative test results(SII=platelets×neutrophils/lymphocytes),using the ROC curve to capture the optimal cut-off value.The SII was divided into two groups.The relationship between SII and clinical pathological factors was analyzed.The survival curve was drawn by Kaplan-Meier method.The single factor analysis was performed by Log-rank method,and the multivariate analysis was performed by COX regression risk model.Results:The optimal SII cut-off value was 427.3.There were 459 patients in the SII≤427.3 group and 364 patients in the SII>427.3 group.SII was associated with age,infiltration,number of lymph node metastases,TNM stage,albumin,pre-albumin,A/G,and CEA(both P<0.05).As of March 2018,there were 514 survivors and 309 deaths,and the overall survival(OS)of patients with SII≤427.3 was significantly better than that of SII>427.3 patients.The difference was statistically significant(P=0.000),single-factor analysis results showed that age,tumor location,differentiation,tumor infiltration,number of lymph node metastasis,TNM stage,albumin count,pre-albumin count,A/G,CEA,CA-199 and SII were associated with prognosis of radically operated gastric cancer patients(P<0.05).Multivariate analysis showed that age(HR=1.487,95%CI=1.162~1.902,P=0.020),tumor location(HR=0.696,95%CI=0.597~0.811,P=0.000),degree of tumor infiltration(HR=2.241,95%CI=1.184~4.244,P=0.013),number of lymph node metastasis(HR=1.337,95%CI=1.121~1.595,P=0.001),TNM staging(HR=1.289,95%CI=1.067~1.558,P=0.008),pre-albumin(HR=0.720,95%CI=0.560~0.926,P=0.010),CA-199(HR=1.513,95%CI=1.204~1.901,P=0.000)and SII(HR=1.577,95%CI=1.253~1.984,P=0.000),were independent risk factors for the prognosis of patients with radical gastric cancer. Conclusion: SII is a reliable prognostic indicator for gastric cancer patients undergoing radical surgery,and high preoperative SII indicates poor prognosis.