术前系统免疫炎症指数与胰腺癌患者预后的关系

Relationship between preoperative systemic immune inflammation index and postoperative prognosis of patients with pancreatic cancer

目的探讨术前系统免疫炎症指数(systemic immune-inflammation index,SII)与胰腺癌(pancreatic ductal adenocarcinoma,PDAC)患者预后的关系。方法回顾性分析2015年1月至2020年12月在郑州大学第二附属医院行胰腺癌切除术的PDAC患者相关临床资料,包括一般资料(年龄、性别、有无基础疾病)、术前1周实验室检验结果(血常规、CA19-9、胆红素水平、肿瘤大小、有无淋巴结转移、肿瘤分化程度)。根据公式(血小板计数×中性粒细胞/淋巴细胞)计算患者术前1周的SII;并采用ROC曲线来确定SII最佳临界值;利用Kaplan-Meier绘制生存曲线;采用Cox单因素和多因素回归分析探讨术前SII与PDAC患者术后生存的关系。结果本研究共纳入150例患者,年龄42.0~79.0岁,平均(60.4±9.9)岁;其中男76例(50.67%),女74例(49.33%)。根据ROC曲线得出的SII最佳分界值为822,将150例患者分为两组:SII>822(n=71)和SII≤822(n=79),利用Kaplan-Meier曲线计算出两组患者术后第1、3、5年的生存率分别为(39.7%、5.7%、0.0%)和(71.8%、37.2%、2.1%),平均生存时间分别为(14.88±1.56)个月和(29.92±2.02)个月,SII≤822组总生存率显著高于SII>822组(P<0.05)。Cox多变量生存分析显示,SII>822、肿瘤>3 cm、有淋巴结转移是影响胰腺癌患者术后预后的独立危险因素(P<0.05)。结论术前SII>822、肿瘤>3 cm、有淋巴结转移是影响胰腺癌患者术后总生存期有关,SII越高,患者的预后越差。

Objective on postoperative prognosis of patients with pancreatic cancer(PDAC).MethodsThe clinical data of PDAC patients who underwent pancreatic cancer resection in the second affiliated Hospital of Zhengzhou University from January2015 to December 2020 were analyzed retrospectively,including general data(age,sex,underlying disease)and the results of laboratory examination one week before operation(blood routine,CA19-9,bilirubin level,tumor size,lymph node metastasis,tumor differentiation).The SII of patients one week before operation was calculated according to the formula:the platelet count×the number of neutrophils/the number of lymphocytes.The best critical value of SII was determined by ROC curve,the survival curve was drawn by Kaplan-Meier,and the relationship between preoperative SII and postoperative survival was discussed by Cox univariate and multivariate regression analysis.ResultsThis study included 150 patients,aged 42.0~79.0(60.4±9.9)years,76 males(50.67%)and74 females(49.33%).According to the ROC curve,the best cut-off value of SII was 822,above which there were71 cases and under which there were 79.By Kaplan-Meier curve,the 1,3,5-year survival rates of the two groups were(39.7%,5.7%,0.0%)and(71.8%,37.2%,2.1%),respectively,the average survival time was(14.88±1.56)months and(29.92±2.02)months,respectively,and the overall survival rate of the SII≤822 group was significantly higher than that of the SII>822 group(P<0.05).By Cox multivariate survival analysis,the independent risk factors for their postoperative prognosis were SII>822,tumor>3 cm and lymph node metastasis(P<0.05).Conclusion preoperative SII>822,tumor>3 cm and lymph node metastasis.The higher the SII,the worse the prognosis.