胃癌患者术前中性粒细胞淋巴细胞比率与淋巴结转移相关性临床研究

Correlation between Preoperative Neutrophil Lymphocyte Ratio in Gastric Cancer Patients with Lymphnode Metastasis

目的 探讨胃癌患者术前中性粒细胞淋巴细胞比率（NLR）与淋巴结转移的关系,指导胃癌术中淋巴结的清扫.方法 回顾2006年1月～ 2008年12月于笔者所在科室行胃癌根治术患者244例,男性184例（75.4％）,女性60例（24.6％）,平均年龄58.3（29 ～85）岁.收集患者术前中性粒细胞计数、淋巴细胞计数、血小板计数.以NLR=4为临界点将患者分为高NLR组及低NLR组.收集患者术中切除淋巴结数,计算淋巴结转移率、转移度.按清扫总数是否＞15枚分为≥15枚组及＜15枚组.按肿瘤大小、Borrmann分型及术中淋巴结清扫进行分层分析.结果 淋巴结转移率（度）,NLR≥4组高于NLR＜4组.淋巴结转移≥N1,NLR≥4的患者比例明显较高,淋巴结分期增高（P＜0.05）.NLR均值高,肿瘤直径≥4cm,BorrmannⅢ、Ⅳ型患者增加.术中淋巴结清扫总数,术前NLR均值偏高者大于偏低者,差异有统计学意义（P＜0.05）.结论 术前NLR对患者术前淋巴结分期有提示作用,可做为术前淋巴结分期的补充并对术中淋巴结清扫有指导意义,可做为术前确定淋巴结清扫范围和清扫数量的参考指标之一.

Objective To explore and analyze neutrophil lymphocyte ratio （NLR） in preoperative gastric cancer patients with the lymphnode metastasis, thus to guide the lymph - adenectomy in stomach gastrectomy. Methods The clinical and pathological data of 244 patients with gastric cancer, who received curative resection in our hospital from January 2006 to December 2008, were analyzed retro- spectively,with 184 men （75.4%） and 60 women （24.6%） , a mean age of 58.3 years（29 -85years）. NLR was calculated from neu- trophil and lymphocyte counts on routine blood tests taken prior to surgery, with NLR 〈 4 and NLR≥4 were classified as low and high NLR group. The rate of lymph node metastasis and the reseeted lymph nodes was colculated , with the number of resected lymph nodes being classified as ≥ 15 and 〈 15 group. Results The total rate of lymph node metastasis in NLR ≥4 were significantly higher than in NLR 〈4（P 〈 0.05）. Multivariate analysis of clinicopathological factors affecting NLR revealed that clinicopathological stages, type of Borrmann＇s, site and maximum diameter of gastric cancer were significant risk factors for increased NLR. NLR increased successively in carcinoma of early, middle and late stages （ P 〈 0.05 ） , and the rate of the infiltrative tumor （ Borrmann ]~ , IV ） was significantly higher. The number of resected lymphnodes in high NLR group was significantly higher than which in low NLR group （P 〈 0.05 ）. Conclusion Preoperative NLR of gastric cancer patients is a biomarker which can be used to forecast lymphnode metastasis, identify lymphnode staging to make preoperative diagnose more accurate, which is quite helpful to make the dissection range and amount clear to avoid excessive or de- ficiency of lymphnode dissection.