基于倾向性评分匹配分析全身免疫炎症指数对胰腺癌患者生存期的预测价值

Prognostic significance of systemic immune inflammation index in patients with pancreatic cancer based on propensity score matching analysis

目的采用倾向性评分匹配分析法探讨全身免疫炎症指数(SII)对胰腺癌患者总生存期的预测价值。方法回顾性分析2000年8月至2019年12月间青岛大学附属医院收治的457例胰腺癌患者的临床资料,记录患者的年龄、性别,有无黄疸、胰腺炎、糖尿病,血CA19-9、总胆红素水平、中性粒细胞计数、血小板计数、淋巴细胞计数,有无行根治性手术,肿瘤TNM分期、肿瘤部位等。通过约登指数确定SII最佳临界值,根据最佳临界值将患者分为高SII组和低SII组,应用倾向性评分匹配分析降低患者选择偏倚,对患者进行1∶2匹配,卡钳值取0.1,比较两组患者总生存期的差异。采用单因素与多因素Cox回归分析患者的预后因素。采用Kaplan-Meier法绘制生存曲线计算累积生存率,通过Log-Rank检验进行曲线之间的差异分析。结果SII最佳临界值为765,倾向性评分匹配前高SII组(125例)和低SII组(332例)的有无胰腺炎、血总胆红素水平、是否根治性手术及TNM分期差异有统计学意义(P值均<0.05)。倾向性评分匹配后,高SII组(113例)和低SII组(182例)间除CA19-9外,其余上述临床指标差异均无统计学意义,具有可比性。单因素分析结果显示,CA19-9水平、SII、是否行根治性手术、不同TNM分期均与胰腺癌患者总生存期相关;多因素分析结果显示,高CA19-9水平、高SII、未行根治性手术切除及更差的TNM分期为患者总生存期短的独立危险因素,其中高SII(HR=1.882,95%CI 1.446~2.450,P<0.001)与患者预后差呈显著相关。高SII组患者总生存期明显短于低SII组(P<0.001),高、低SII组患者平均生存期分别为8.86、11.38个月。结论SII对评估胰腺癌患者总生存期具有重要的价值,SII越高,总生存期越短。

Objective To investigate the predictive value of systemic immune inflammation index(SII)for the overall survival of patients with pancreatic cancer by propensity score matching analysis.Methods The clinical data of 457 patients with pancreatic cancer admitted to the Affiliated Hospital of Qingdao University from August 2000 to December 2019 were retrospectively analyzed.The age,gender,presence of jaundice,pancreatitis and diabetes,serum CA19-9,total bilirubin level,neutrophil count,platelet count,lymphocyte count in blood,presence of radical surgery,tumor TNM stage,tumor location and the like were recorded.The cut-off value of SII was determined by Youden index.The patients were divided into high and low SII groups accroding to the cut-off value.The propensity score matching was applied to reduce the selection bias of patients.Patients were 1∶2 matched and the caliper value was 0.1.The difference on overall survival between the two groups was compared.The prognostic factors were analyzed by univariate and multivariate Cox regression analysis.Kaplan-Meier was used to draw the overall survival curve to calculate the cumulative survival rate,and the differences between the curves were analyzed by Log-Rank test.Results The cut-off value of SII was 765.There were statistically significant differences between the high SII group(n=125)and the low SII group(n=332)on the presence or absence of pancreatitis,the level of total bilirubin in blood,radical surgery,and TNM stage before the propensity score matching(all P value<0.05).After propensity score matching,there was no statistically significant difference between the high SII group(n=113)and the low SII group(n=182)on all the clinical parameters mentioned above except for CA19-9,indicating that the two groups were comparable.Univariate analysis showed that the level of CA19-9,SII,radical surgery and different TNM stage were all related to the overall survival of pancreatic cancer patients.Multivariate analysis showed that high CA19-9 level,high SII,no radical surgery,and worse TNM stage were independent risk factors for short overall survival,and high SII(HR=1.882,95%CI 1.446-2.450,P<0.001)was significantly associated with poor prognosis.The overall survival of patients with high SII was obviously shorter than the low SII group(P<0.001),and the average survival time of patients with high and low SII were 8.86 and 11.38 months,respectively.Conclusions SII is of great value in evaluating the overall survival of pancreatic cancer patients.Higher SII is associated with shorter overall survival.