外周血小板淋巴细胞比值变化在新辅助化疗胃癌患者预后中的价值

Study on the dynamic changes of peripheral platelet-to-lymphocyte ratio in the prognosis of neoadjuvant chemotherapy patients with gastric cancer

目的:探讨新辅助化疗前后血小板淋巴细胞比值(PLR)变化在进展期胃癌中的意义。方法:回顾性收集2015年5月至2016年10月247例在河南省肿瘤医院接受新辅助治疗的进展期胃癌行根治性切除术的247例患者资料。其中男174例,女73例,年龄20~84岁,中位年龄61岁。依据新辅助治疗前后PLR的差值状态定义△PLR,如为负值定义为“降低组”,如为正值或是0定义为“未降低组”。进一步分析新辅助治疗前后PLR值及其变化与患者临床病理特征及预后的关系。结果:247例患者包含降低组138例和未降低组109例;△PLR两组间在肿瘤大小、侵犯神经、脉管癌栓、ypT分期、ypN分期、ypTNM分期和病理反应之间差异均有统计学意义(均P<0.05),而在年龄、性别、和有无术后辅助化疗之间差异均无统计学意义(均P>0.05)。生存分析显示△PLR降低组和未降低组的5年无病生存率分别为39.0%和54.0%(P=0.025);5年总生存率分别为41.8%和58.1%(P=0.035);未降低组患者无病生存率和总生存率明显好于降低组,差异有统计学意义。多因素分析结果显示:ypT3-4分期、ypN3b分期和△PLR是影响进展期胃癌患者5年无病生存率[HR=2.731/2.676,95%可信区间(CI):1.026~7.268/1.014~6.985;HR=4.717,95%CI:1.922~11.579;HR=2.854,95%CI:1.117~4.124;均P<0.05)]和总生存率(HR=3.226/2.655,95%CI:1.280~9.227/0.945~7.548;HR=4.550,95%CI:1.842~11.239;HR=2.897,95%CI:1.049-5.251;均P<0.05)的独立危险因素。结论:接受新辅助化疗的进展期胃癌患者△PLR能更好地预测预后。

Objective To investigate the significance of platelet lymphocyte ratio(PLR)before and after neoadjuvant chemotherapy in advanced gastric cancer(AGC).Methods The medical records of 247 AGC patients who underwent surgery between May 2015 and October 2016 were retrospectively reviewed.The relationship between PLR value and its changes before and after neoadjuvant therapy and clinicopathological features and prognosis was further analyzed.Results△PLR was defined according to the different states of PLR before and after neoadjuvant therapy.If negative value was defined as"Reduced Group"(138)and positive value or 0 was defined as"Unreduced group"(109).There were statistical differences between the two groups of△PLR in tumor size,nerve invasion,presence or absence of vascular tumor thrombus,ypT staging,ypN staging,ypTNM staging,and pathological response(all P<0.05),but there was no statistical difference between age,gender,and postoperative adjuvant chemotherapy(all P>0.05).Survival analysis showed that the 5-year disease-free survival rates between the two groups were 39.0%and 54.0%,respectively(P=0.025);the 5-year overall survival rates between the two groups were 41.8%and 58.1%,respectively(P=0.035);the difference were statistically significant.Multivariate analysis showed that ypT3-4 stage,ypN3b stage and△PLR were independent risk factors for 5-year disease-free survival rate(HR=2.731/2.676,95%CI:1.026-7.268/1.014-6.985;HR=4.717,95%CI:1.922-11.579;HR=2.854,95%CI:1.117-4.124;all P<0.05)and 5-year overall survival rate(HR=3.226/2.655,95%CI:1.280-9.227/0.945-7.548;HR=4.550,95%CI:1.842-11.239;HR=2.897,95%CI:1.049-5.251;all P<0.05).Conclusion△PLR can better predict the prognosis of AGC patients receiving neoadjuvant chemotherapy.