术前系统性炎症反应指数对胆囊癌病人预后的影响

The influence of preoperative systemic inflammation response index on the prognosis of patients with gallbladder cancer

目的探讨术前系统性炎症反应指数(systemic inflammation response index,SIRI)在评估胆囊癌病人预后中的价值。方法选取2009年1月至2019年2月在都江堰市医疗中心普外科接受外科治疗并经病理确诊为胆囊癌的126例病人为研究对象。收集所有病人临床病理资料。根据术前外周血中性粒细胞、淋巴细胞和单核细胞计数绝对值计算SIRI。绘制SIRI评估病人术后生存状态的受试者工作特征(ROC)曲线,通过Youden指数确定最佳分界值,以此分界值将病人分为高SIRI组和低SIRI组。比较两组临床病理资料;采用Kaplan-Meier模型对两组总生存时间(OS)进行分析;病人OS的独立危险因素采用多因素Cox比例风险回归模型分析。结果根据ROC曲线确定SIRI最佳分界值为1.398。126例病人中低SIRI组(SIRI<1.398) 81例,高SIRI组(SIRI≥1.398) 45例;两组病理分化程度、Nevin分期、浸润深度、是否淋巴结转移、手术方式比较差异有统计学意义(P<0.05);Kaplan-Meier分析结果显示,高SIRI组OS短于低SIRI组(P<0.05);多因素Cox分析显示,Nevin分期、是否淋巴结转移、手术方式和术前SIRI值均是影响病人OS的独立危险因素(P<0.05)。结论术前SIRI值是影响胆囊癌病人预后独立危险因素,有望成为预测病人术后生存状况的炎性标志物。

Objective To explore the value of preoperative systemic inflammation response index(SIRI) in evaluating the prognosis of patients with gallbladder cancer.Methods From January 2009 to February 2019,126 patients with gallbladder cancer confirmed by pathology who received surgical treatment in general surgery of Dujiangyan medical center were selected as the study object.The clinical and pathological data of all patients were collected.SIRI was calculated according to the absolute number of of peripheral blood neutrophils,lymphocytes and monocytes before operation.To draw the ROC curve of patients with SIRI to evaluate their postoperative survival status,and to determine the best boundary value by Youden index,and then divide the patients into high SIRI group and low SIRI group.The clinicopathological data of the two groups were compared.Kaplan Meier model was used to analyze the total survival time(OS) of the two groups.The independent risk factors of patients with OS were analyzed by multivariate Cox proportional risk regression model.Results The best boundary value of SIRI is 1.398 by ROC curve.There were 81 cases in low SIRI group(SIRI <1.398) and 45 cases in high SIRI group(SIRI ≥1.398).There were significant differences in pathological differentiation,Nevin stage,infiltration depth,lymph node metastasis and operation mode between the two groups(P<0.05).Kaplan Meier analysis showed that OS of high SIRI group was shorter than that in low SIRI group(P<0.05).Multivariate Cox analysis showed that Nevin stage,lymph node metastasis,operation mode and preoperative SIRI were independent risks factor for OS in patients with gallbladder cancer(P<0.05).Conclusion The preoperative SIRI value is an independent risk factor for the prognosis of patients with gallbladder cancer,and it is expected to be an inflammatory marker to predict the postoperative survival status of patients.