系统免疫炎症指数对食管癌放疗患者预后的影响

Effects of systemic immune-inflammation index on prognosis of patients with esophageal carcinoma receiving radiotherapy

目的:观察食管癌患者放疗过程中系统免疫炎症指数(systemic immuneinflammation index,SII)的变化趋势,并且分析SII与预后的相关性。方法:收集2013—2017年在河北医科大学第四医院接受根治性放疗的符合病例选择标准的106例食管癌患者的临床资料,根据放疗前、放疗期间每周以及放疗结束时的血常规检查结果,计算SII,按照受试者工作特征(receiver operating characteristic,ROC)曲线得到SII最佳临界值,对患者进行分组,评估SII的变化趋势。应用Kaplan-Meier法计算生存率,COX风险回归模型分析食管癌放疗患者的预后影响因素。结果:应用ROC曲线确定放疗前SII最佳临界值为646.8。放疗前SII与TNM分期相关(P=0.028),与血清前白蛋白(prealbumin,PAB)和白蛋白(albumin,ALB)呈负相关(P=0.002和P<0.001)。SII在放疗期间呈上升趋势。106例患者1年、3年和5年总生存率分别为76.4%、36.6%和22.9%,中位生存期为24.2个月(95%置信区间:18.974~29.426)。放疗前高SII组患者1年、3年和5年总生存率分别为62.7%、26.3%和15.0%,低SII组患者1年、3年和5年总生存率分别为89.1%、46.4%和30.2%,2组的差异有统计学意义(P=0.003)。单因素分析结果显示,病变部位、TNM分期、放疗方式、放疗处方剂量、化疗和SII是食管癌患者总生存的影响因素(P<0.05)。多因素分析结果显示,TNM分期、放疗处方剂量和SII是食管癌患者总生存的独立影响因素(P<0.05)。高SII组患者≥2级放射性食管炎和放射性肺炎的发生率均高于低SII组患者(P<0.05)。结论:SII在放疗期间呈上升趋势,是食管癌放疗患者预后的独立影响因素。

Objective:To investigate the change trend of systemic immune-inflammation index(SII)of the patients with esophageal squamous cell carcinoma(ESCC)undergoing radical radiotherapy and to determine the prognostic value of SII.Methods:The clinical records of eligible 106 patients with ESCC who underwent radical radiotherapy in the Fourth Hospital of Hebei Medical University from 2013 to 2017 were retrospectively analyzed.The SII was calculated based on the routine blood examination which was performed weekly before,during and after radiotherapy.The optimal cut-off value of SII was determined by the receiver operating characteristic(ROC)curve.The change trend of SII was assessed.The overall survival(OS)was calculated by Kaplan-Meier method.The prognostic factors of ESCC patients undergoing radiotherapy were analyzed by COX regression analysis.Results:The optimal cut-off value of SII before radiotherapy determined by ROC curve was 646.8.SII level before radiotherapy was significantly related to TNM stage(P=0.028)and was negatively correlated with serum prealbumin(PAB)and albumin(ALB)levels(P=0.002 and P<0.001).SII displayed an increase trend during radiotherapy.For all patients,the 1-,3-and 5-year OS rates were 76.4%,36.6%and 22.9%,respectively.The median OS for overall patients was 24.2 months(95%confidence interval:18.974-29.426).The 1-,3-,5-year OS rates of high SII group were 62.7%,26.3%and 15.0%,respectively,which were significantly lower than 89.1%,46.4%and 30.2%of low SII group(P=0.003).Univariate analysis showed that the tumor location,TNM stage,irradiation method,radiotherapy dose,adjuvant chemotherapy and the SII level were significantly associated with OS of patients with ESCC(all P<0.05).In the multivariate analysis,the TNM stage,radiotherapy dose and SII were confirmed as independent prognostic factors for OS of patients with ESCC(all P<0.05).The incidence rates of≥grade 2 radiation esophagitis and radiation pneumonitis of high SII group were higher than those of low SII group(all P<0.05).Conclusion:SII displays an increase trend during radiotherapy.The SII is a useful independent prognostic indicator for patients with esophageal squamous cell carcinoma undergoing radical radiotherapy.