疗前外周血NE值和LMR对局部进展期胃癌术前治疗后病理反应的预测价值

The predicting value of pretreatment neutrophil count and lymphocyte-to-monocyte ratio in peripheral blood for the pathological tumor responses in patients with locally advanced gastric adenocarcinoma after preoperative therapy

目的探讨局部进展期胃腺癌患者疗前多项血液指标对术前新辅助治疗后肿瘤病理反应的预测价值。方法回顾分析2013—2019年间一项多中心Ⅲ期临床试验中的102例患者疗前外周血中性粒细胞(NE)、淋巴细胞(LY)和单核细胞(MO)绝对值。患者分为术前化疗组(3个疗程XELOX方案化疗)和术前放化疗组(XELOX诱导化疗1个疗程及4500cGy分25次放疗同期XELOX减量化疗2个疗程),各51例。胃癌根治术后的肿瘤病理反应指标包括原发肿瘤消退等级、病理完全缓解、病理T和N分期(ypT和ypN)与TNM分期(ypTNM)。结果单因素回归模型及ROC曲线分析显示NE与ypT降期、LMR(LY/MO)与ypN0、LMR与ypTNM降期有显著相关性。多因素回归分析结果显示高NE组患者(>4.10×10^(9)/L)有更高的ypT降期概率(OR=3.308,P=0.007);高LMR组(>3.46)有更高的ypN0概率(OR=4.276,P=0.005)与更高的ypTNM降期概率(OR=2.805,P=0.019)。亚组分析显示术前放化疗组中高NE组患者有更高的ypT降期概率(OR=3.750,P=0.030),而术前化疗组中高LMR患者有着更高的ypN0概率(OR=8.500,P=0.050)与肿瘤降期概率(OR=4.000,P=0.026)。结论疗前外周血NE和LMR可用作术前治疗后肿瘤病理反应的独立预测因素,患者免疫状态与局部晚期胃癌术前治疗后肿瘤退缩程度相关。

Objective To analyze the predicting values of hematological indicators for the pathological response in patients with gastric adenocarcinoma after preoperative neoadjuvant therapy and radical surgery.Methods The absolute count of neutrophils(NE),lymphocytes(LY)and monocytes(MO)of 102 patients with locally advanced gastric adenocarcinoma in a multi-center randomized phaseⅢclinical trial(NCT01815853)from June 2013 to Feburary 2019 were retrospectively analyzed.Patients were divided into the chemotherapy alone group(ChT,3 cycles of XELOX regimen)and the chemoradiation group(CRT,1 cycle of induced XELOX regimen and 4500 cGy/25f radiotherapy plus concurrent extenuated 2 cycles of XELOX regimen),51 cases in each group.The pathological response indicators of tumors after radical surgery included tumor regression grade,pathological complete regression,pathological T stage(ypT),N stage(ypN)and TNM stage(ypTNM).Results Univariate regression analysis and ROC curves demonstrated a significant association between the absolute neutrophil count(NE)and ypT,lymphocyte-to-monocyte ratio(LMR)and ypN0,and LMR and ypTNM reduction in the entire cohort of patients.Multivariate regression analysis showed that higher NE(>4.10×10^(9)/L)was significantly associated with higher probability of ypT reduction(OR=3.308,P=0.007).Higher LMR(>3.46)was significantly associated with higher ypN0 probability(OR=4.276,P=0.005)and better ypTNM reduction(OR=2.805,P=0.019).In subgroup analysis,higher NE(>4.10)was significantly correlated with higher probability of ypT reduction(OR=3.750,P=0.030)in the CRT group,and higher LMR(>3.46)was significantly associated with higher ypN0 probability(OR=8.500,P=0.050)and the probability of ypTNM stage reduction(OR=4.000,P=0.026)in the ChT group.Conclusions Pretreatment NE and LMR in the peripheral blood serve as independent predictors for tumor pathological responses after preoperative treatment,and immune condition is correlated with tumor regression after radical surgery in patients with locally advanced gastric cancer.