术前血小板与淋巴细胞比值、淋巴细胞与单核细胞比值与胃癌病人预后的关系

Association between PLR,LMR and prognosis of patients with gastric cancer

目的探讨术前血小板与淋巴细胞比值(PLR)、淋巴细胞与单核细胞比值(LMR)与胃癌病人预后的关系。方法收集安徽医科大学第一附属医院2015年10月至2017年4月收住的胃癌病人900例,根据3年生存率绘制的受试者工作特征(ROC)曲线确定PLR及LMR值的截点,分为低PLR组(PLR<140.35)、高PLR组(PLR≥140.35)和低LMR组(LMR<4.88)、高LMR组(LMR≥4.88)四组,比较四组临床病理资料,采用单因素及多因素分析影响胃癌病人预后的因素,比较各组生存期和生存率,绘制相应生存曲线。结果低PLR组与高PLR组癌胚抗原(CEA)、CA19-9、T分期、N分期、病理学TNM分期、鲍曼分型、分化程度、肿瘤直径及3年生存状态比较,均差异有统计学意义(P<0.05),低LMR组和高LMR组性别、年龄、CEA、CA19-9、T分期、N分期、病理学TNM分期、鲍曼分型、肿瘤直径及3年生存状态比较,均差异有统计学意义(P<0.05),COX回归分析显示,CEA、CA19-9、TNM分期、肿瘤直径及LMR是胃癌病人预后的独立影响因素。3年总生存率比较,低PLR组和高PLR(88.0%比46.7%),低LMR组和高LMR组(56.9%比89.9%),均差异有统计学意义(P<0.05)。低PLR高LMR组、高PLR高LMR组、低PLR低LMR组及高PLR低LMR组生存期分别为(55.801±0.509)月,(49.306±1.461)月,(49.634±1.017)月,(27.884±1.242)月,3年生存率分别为94.4%、76.4%、79.5%、30.0%,四组生存率比较,差异有统计学意义(P<0.008)。结论术前高PLR及低LMR是影响胃癌病人预后的独立危险因素。高PLR低LMR的胃癌病人预后更差。

Objective To explore the correlation between preoperative platelet/lymphocyte ratio(PLR),lymphocyte/monocyte ratio(LMR)and prognosis of patients with gastric cancer.Methods A total of 900 patients with gastric cancer admitted to The First Affiliated Hospital of Anhui Medical University from October 2015 to April 2017 were enrolled in the study.According to the 3-year survival rate of these patients,the receiver operating characteristic(ROC)curve was drawn to determine the cut-off points of PLR and LMR values to further assign these patients into four groups:low PLR group(PLR<140.35),high PLR group(PLR≥140.35),low LMR group(LMR<4.88)and high LMR group(LMR≥4.88).The clinicopathological data of the four groups were compared,and univariate and multivariate analysis were used to find out the factors affecting the prognosis of patients with gastric cancer.The survival time and survival rates of the groups were compared,and the corresponding survival curves were drawn.Results There were significant differences in carcinoembryonic antigen(CFA),CA19-9,T staging,N staging,pathological TNM staging,Borrmann classification,degree of differentiation,tumor size and 3-year survival status between low PLR group and high PLR group(P<0.05),and there were significant differences in gender,age,CFA,CA19-9,T staging,N staging,pathological TNM staging,Borrmann classification,tumor size and 3-year survival status between low LMR group and high LMR group(P<0.05).COX regression analysis results showed that CEA,CA19-9,TNM staging,tumor size and LMR were independent prognostic factors of patients with gastric cancer.Survival analysis showed that there were statistical differences in the overall 3-year survival rates between low PLR group and high PLR group(88.0%vs.46.7%),and between low LMR group and high LMR group(56.9%vs.89.9%)(P<0.05).The patients were further assigned into four groups:low PLR and high LMR group,high PLR and high LMR group,low PLR and low LMR group,high PLR and low LMR group.The average survival time was(55.801±0.509)months,(49.306±1.461)months,(49.634±1.017)months and(27.884±1.242)months,respectively.The 3-year survival rates were 94.4%,76.4%,79.5%and 30.0%.There was significant difference in the overall survival rate among the four groups(P<0.008).Conclusion Preoperative high PLR and low LMR are independent risk factors affecting the prognosis of patients with gastric cancer.And the prognosis of those with high PLR and low LMR is worse than other patients.