术前系统免疫炎症指数对远端胆管癌患者术后预后的评估价值

Value of preoperative systemic immune inflammatory index in postoperative prognostic evaluation of patients with distal cholangiocarcinoma

背景与目的:远端胆管癌(DCC)发病隐匿,恶性程度高,早期诊断困难,患者确诊时大多数已经进展至中晚期,多已不具备根治性治疗的条件。因此,寻求可靠的DCC血清学标志物对于早期诊断与治疗获益评估具有重要的意义。系统免疫炎症指数(SII)是通过淋巴细胞、中性粒细胞和血小板计数计算获得的综合炎症指标,其被应用于多种恶性肿瘤的预后评估,然而在DCC患者中的应用价值尚未明确。因此,本研究探讨SII对行胰十二指肠切除术(PD)后的DCC患的预后评估价值。方法:对2010年1月-2016年6月期间117例在辽宁省健康产业集团阜新矿总医院行PD术的DCC患者进行回顾性分析。采用ROC曲线分析术前SII、血小板与淋巴细胞比值(PLR)、中性粒细胞与淋巴细胞比值(NLR)对DCC患者5年总生存率(OS)的预测效能,并确定SII评估DCC患者预后的最佳临界值。分析SII与患者临床病理特征的关系,并采用单因素与多因素分析确定DCC患者术后生存的危险因素。结果:术前SII对患者术后5年OS的预测效能(AUC=0.649)高于PLR (AUC=0.595)和NLR (AUC=0.552),其最佳临界值975。高SII组(SII>975)中术前胆管炎、高CEA于CA19-9水平及术中失血量大的患者比例高于低SII组(SII≤975),差异均有统计学意义(均P<0.05),两组之间复发比例、复发部位及其他临床特征的差异均无统计学意义(均P>0.05)。全组患者术后中位生存期为49 (19~104)个月。单因素分析结果表明,术前CA19-9水平、血管受侵、淋巴结转移、T分期、门静脉重建、根治程度及术前SII与DCC患者术后5年OS有关(均P<0.05)。多因素分析显示,伴有淋巴结转移(HR=2.406,95%CI=1.437~4.026, P=0.001)、门静脉重建(HR=1.549, 95%CI=1.075~2.365, P=0.043)及SII>975(HR=1.793,95%CI=1.205~2.668,P=0.015)是DCC患者术后5年OS的独立危险因素。结论:术前SII是预测DCC患者术后预后的有效指标,术前SII>975提示DCC患者术后预后较差,对于此类患者应加强术后随访,积极寻求其他治疗措施。

Background and Aims:Distal cholangiocarcinoma(DCC) is characterized by insidious onset,high degree of malignancy,and difficult early diagnosis.Most patients have progressed to the middle or late stage at the time of diagnosis,with no chance for radical treatment.So,identifying reliable serum markers of DCC is of great importance for early diagnosis and treatment benefit assessment.The systemic immune-inflammatory index(SII) calculated by lymphocyte,neutrophil and platelet and counts is a comprehensive inflammatory index,and has been used for prognostic analysis in variety of malignant conditions.However,its application value in DCC patients has not been demonstrated.Therefore,this study was conducted to investigate the prognostic value of SII in DCC patients after pancreatoduodenectomy(PD).Methods:The clinical data of 117 DCC patients undergoing PD in Fuxin Mining General Hospital of Liaoning Health Industry Group from January 2010 to June 2016 were retrospectively analyzed.Using the ROC curve approach,the performances of preoperative SII,platelet-lymphocyte ratio(PLR) and neutrophil-lymphocyte ratio(NLR) in predicting the 5-year overall survival(OS) of DCC patients were rated,and the optimal cut-off vale of SII to evaluate the prognosis of DCC patients was determined.The relations of SII with the clinicopathologic characteristics of the patients were analyzed,and the risk factors for postoperative survival of the patients were determined by univariate and multivariate analyses.Results:The prediction efficiency of preoperative SII(AUC=0.649) was higher than that either of PLR(AUC=0.595) or NLR(AUC=0.552),and its cut-off value was 975.In high SII group(SII>975),the proportions of patients with preoperative cholangitis,high levels of CEA and CA19-9 and large intraoperative blood loss were higher than those in the low SII group(SII≤975),with statistical significance(all P<0.05),while there were no significant differences in recurrence rate,recurrence site and other clinicopathologic variables between the two groups(all P>0.05).The median survival time for the entire group was 49(19-104) months.Univariate analysis showed that preoperative CA19-9 level,vascular invasion,lymph node metastasis,T stage,portal vein reconstruction,degree of radical resection,and preoperative SII were significantly associated with the postoperative 5-year OS of DCC patients(all P<0.05).Multivariate analysis revealed that the presence of lymph node metastasis(HR=2.406,95% CI=1.437-4.026,P=0.001),portal vein reconstruction(HR=1.549,95% CI=1.075-2.365,P=0.043),and SII>975(HR=1.793,95% CI=1.205-2.668,P=0.015) were independent risk factors for postoperative 5-year OS of DCC patients.Conclusion:Preoperative SII is an effective indicator for predicting the postoperative prognosis in DCC patients.DCC patients with SII>975 may face a poor postoperative prognosis,and for them the followup should be strengthened and other treatment measures should be considered.