炎症反应与中晚期食管癌患者放射治疗预后的相关性分析

Relationship between inflammatory response and radiotherapy in patients with advanced esophageal cancer

目的探讨炎症反应[中性粒细胞与淋巴细胞比值(NLR)、C反应蛋白(CRP)、格拉斯哥预后评分(GPS)]评估中晚期食管癌患者放射治疗预后的价值。方法选取2013年1月至2016年1月山西省肿瘤医院放射治疗胸部二病区收治的52例首次行放射治疗的老年食管癌患者,男34例,女18例,中位年龄72岁,年龄范围为60~83岁,对其临床资料进行回顾性分析。利用ROC曲线确定NLR、CRP、GPS的最佳界值,并分析放射治疗后NLR、CRP、GPS及其较放射治疗前降低情况(△NLR、△CRP、△GPS)与患者预后的关系。结果 NLR≤1.55患者的治疗效果优于NLR>1.55者,差异有统计学意义(P<0.05);而CRP、GPS的高低与患者近期治疗效果比较,差异无统计学意义(P>0.05)。所有患者的中位生存时间为19个月。高NLR患者中位生存时间(19个月)显著短于低NLR患者(39个月),高CRP患者中位生存时间(19个月)显著短于低CRP患者(38个月),高GPS患者的中位生存时间(16个月)显著短于低GPS患者(32个月),差异有统计学意义(P<0.05)。△NLR、△CRP、△GPS放射治疗后炎症指标升高者中位生存时间(38个月、33个月、31个月)长于放射治疗后炎症指标降低者(22个月、22个月、18个月),差异有统计学意义(P<0.05)。根据ROC曲线下面积,NLR对总生存时间的预测价值优于CRP、GPS,△NLR对总生存时间的预测价值优于△CRP、△GPS,差异有统计学意义(P<0.05)。多因素分析结果显示,NLR、GPS均为独立预后危险因素,差异有统计学意义(P<0.05)。结论炎症指标NLR、CRP、GPS是中晚期食管癌患者放射治疗后的有效预测指标,其放射治疗前后的差值可辅助反应患者的预后情况。

Objective To evaluate the value of inflammatory response[neutrophil to lymphocyte ratio(NLR),C-reactive protein(CRP),Glasgow prognosis score(GPS)]in evaluating the prognosis of patients with advanced esophageal cancer after radiotherapy.Methods A retrospective study was performed on 52 cases of elderly patients with esophageal cancer who were admitted in The Second Department for Chest Radiotherapy of Shanxi Tumor Hospital from January 2013 to January 2016.The clinical data of 34 males and 18 females,with a median age of 72 years,ranged from 60 to 83 years old,were analyzed retrospectively.ROC curve was used to determine the optimal threshold values of NLR,CRP and GPS,and to analyze the relationship between NLR,CRP,GPS and prognosis after radiotherapy(△NLR,△CRP,△GPS).Results The therapeutic effect of patients with NLR≤1.55 was better than that with>1.55,the difference was statistically significant(P<0.05);while the level of CRP and GPS was not statistically significant compared with the patients′recent treatment effect(P>0.05).The median survival time for all patients was 19 months.The median survival time of the high NLR group(19 months)was significantly shorter than that of the low NLR group(39 months),and the median survival time of the high CRP group(19 months)was significantly shorter than that of the low CRP group(38 months).The median survival time of the group(16 months)was significantly shorter than that of the low GPS group(32 months),the difference was statistically significant(P<0.05).The median survival time(38 months,33 months,31 months)of patients with elevated inflammation indicators after radiotherapy was longer than those with reduced inflammation indicators(22 months,22 months,18 months),the difference was statistically significant(P<0.05).According to the area under the ROC curve,the predictive value of NLR for total survival time is better than CRP and GPS,and the predictive value of△NLR for total survival time is better than△CRP and GPS,the difference is statistically significant(P<0.05).Multivariate analysis showed that NLR and GPS were independent prognostic risk factors,and the difference was statistically significant(P<0.05).Conclusion Inflammation indexes NLR,CRP and GPS are effective predictive indexes for patients with advanced esophageal cancer after radiotherapy.The difference between before and after radiotherapy can help reflect the prognosis of patients.