食管癌患者放疗前系统免疫炎症指数对长期生存的影响分析

Effects of systemic immune-inflammation index on long-term survival in esophageal cancer patients treated with radiotherapy

目的分析系统免疫炎症指数(SII)对接受根治性放疗的食管癌患者长期生存的影响。方法回顾性分析2011年至2017年于河北医科大学第四医院接受根治性放疗的303例食管癌患者的临床资料,依据放疗前SII将患者分为高SII组(SII>648)和低SII组(SII≤648),采用Kaplan-Meier法计算总生存率(OS)和无进展生存率(PFS),Cox回归模型进行生存预后的单因素和多因素分析,采用倾向得分匹配法减少选择偏倚。结果所有入组患者放疗前SII水平与T分期和TNM分期显著相关(χ^(2)=8.015、8.619,P=0.018、0.013)。高SII组OS和PFS均低于低SII组,差异均有统计学意义(χ^(2)=13.443、12.383,P<0.001)。高SII组和低SII组1、3、5年OS分别为64.9%、27.1%、19.4%和84.9%、43.9%、30.5%,高SII组和低SII组1、3、5年PFS分别为46.4%、20.3%、13.3%和67.8%、34.8%、26.5%。多因素预后分析显示,T分期、淋巴结转移、化疗和SII为总生存和无进展生存的独立影响因素,经倾向得分匹配后,高SII组OS(χ^(2)=4.264,P=0.039)和PFS(χ^(2)=5.376,P=0.020)仍低于低SII组,匹配后的多因素分析显示,SII仍然是OS(HR=1.357,P=0.037)和PFS(HR=1.393,P=0.022)的独立影响因素。结论SII是食管癌根治性放疗患者生存的独立影响因素,可作为预后的有效预测指标。

Objective To investigate the effects of the systemic immune-inflammation index(SII)on the long-term survival in esophageal cancer patients treated with radiotherapy.Methods Aretrospective review was conducted for the clinical data of 303 patients with esophageal squamous cell carcinoma(ESCC)who received radical radiotherapy in the Fourth Hospital of Hebei Medical University from 2011 to 2017.These patients were divided into a high-SII group and a low-SII group according to their SII before radiotherapy.The correlation between SII and survival was determined using the Kaplan-Meier method and Cox regression model.Propensity score matching(PSM)was applied to reduce bias from measured confounding.Results The SII of patients before radiotherapy was correlated significantly with T stage(χ^(2)=8.015,P=0.018)and TNM stage(χ^(2)=8.619,P=0.013).The 1-,3-,5-year overall survival(OS)rates in the high-SII group were 64.9%,27.1%,and 19.4%,respectively.They were significantly lower than those in the low-SII group,which were 84.9%,43.9%,and 30.5%,respectively(χ^(2)=13.443,P<0.001).The 1-,3-,5-year progression-free survival(PFS)rates in the high-SII group were 46.4%,20.3%,and 13.3%,respectively.They were significantly lower than those in the low-SII group,which were 67.8%,34.8%,and 26.5%,respectively(χ^(2)=12.383,P<0.001).The multivariate analysis indicated that the independent factors influencing the OS and PFS included T stage,lymph node metastasis,chemotherapy,and SII.After PSM was applied,the OS and PFS in the high-SII group were still lower than those in the low-SII group(χ_(OS)^(2)=4.264,P=0.039;χ_(PFS)^(2)=5.376,P=0.020),and the multivariate analysis showed that SII was a significant predictor for OS and PFS(HR_(OS)=1.357,P=0.037;HR_(PFS)=1.393,P=0.022).Conclusions SII is a significant independent influencing factor of the OS and PFS inESCC patients treated with received radiotherapy.Based on simple and inexpensive standard laboratory measurements,SII can be a promising marker for ESCC patients.