术前纤维蛋白原和中性粒细胞淋巴细胞比值评估胃癌切除术患者预后的临床研究

Clinical value of the combination of fibrinogen and neutrophilic lymphocyte ratio for the prognosis of gastric cancer patients

目的:探讨术前纤维蛋白原(FBG)和中性粒细胞淋巴细胞比值(NLR)联合检测评估胃癌切除术患者预后的临床价值。方法:回顾性分析2010年1月至2014年10月在盘锦辽油宝石花医院普通外科行胃癌切除术并具有完整随访资料的195例患者的临床资料。依据中性粒细胞淋巴细胞比值和术前纤维蛋白原水平进行赋值分组,FBG正常为0分,FBG升高为1分,低NLR为0分,高NLR为1分,分为A组(F-NLR=0分)、B组(F-NLR=1分),C组(F-NLR=2分)。采用卡方检验比较各组临床病理特征,Log-rank方法比较各组患者术后5年总生存率,采用Cox回归模型进行单因素和多因素预后分析。结果:术前NLR与T分期(P=0.011)、N分期(P=0.018)、TNM分期(P=0.009)、术前CEA水平(P=0.013)和FBG水平(P=0.018)相关。高NLR组5年生存率为56.1%,低NLR组为74.4%,差异有统计学意义(P=0.013);高FBG组5年生存率为55.3%,FBG正常组为73.4%,差异有统计学意义(P=0.016);F-NLR分值越高,T分期(P=0.019)、N分期(P=0.030)、TNM分期(P=0.002)和术前CEA水平(P=0.014)等越高。F-NLR分值为0、1、2的患者5年生存率分别为80.8%、61.4%和38.5%(P<0.001)。Cox多因素分析显示,术前FBG和NLR均升高是根治性胃癌切除术患者预后不佳的独立危险因素。结论:FBG和NLR联合检测可以评估胃癌切除术预后,较单独应用FBG和NLR具有更大的临床价值。

Objective:This study compared the combined index of fibrinogen and NLR(F-NLR)with NLR alone for predicting the prognosis of gastric cancer patients.Methods:The retrospective study that the clinical data of 195 patients who underwent gastrectomy in the general surgery department of Panjin Liao-Oil Gem Flower hospital from January 2010 to October 2014.The groups were designed according to neutrophilic lymphocyte ratio and preoperative fibrinogen level.Clinicopathological characteristics between the two groups were compared by using chi-square test as appropriate.The 5-year overall survival rate were estimated with the Kaplan-Meier method and differences between two groups were assessed with the log-rank test.Univariate and multivariate analyses were performed through Cox regression model.Results:There were significant differences between high preoperative NLR and T stage(P=0.011),N stage(P=0.018),TNM stage(P=0.009),CEA level(P=0.013)and fibrinogen level(P=0.018).The 5-year survival rate was 56.1%in the high NLR group and 74.4%in the low NLR group(P=0.013).The 5-year survival rate was 55.3%in the high FBG group and 73.4%in the normal FBG group(P=0.016).The higher the F-NLR score,the higher the T stage(P=0.027),N stage(P=0.032),TNM stage(P=0.008)and preoperative CEA level(P=0.021).The 5-year survival rates of patients in the three groups were 80.8%,61.4% and 38.5%,respectively(P<0.001).Cox multivariate analysis showed that preoperative high Fibrinogen and high NLR(F-NLR 3)was an independent and statistically significant prognostic factor for poor prognosis.Conclusion:F-NLR was an independent prognostic factor in patients with gastric cancer.It has greater clinical value for poor prognosis than FBG and NLR alone.