术前超敏C反应蛋白联合中性粒细胞/淋巴细胞比值在转移性胃癌中的预后预测价值

Prognostic value of preoperative high-sensitivity C-reactive protein combined with neutrophil/lymphocyte ratio in metastatic gastric cancer

目的探讨超敏C反应蛋白联合中性粒细胞/淋巴细胞比值(hsC-NLR)在预测接受手术治疗的转移性胃癌患者预后中的价值。方法回顾性收集2013年1月至2021年9月在中山大学附属第六医院接受手术治疗的转移性胃癌患者的临床病理资料。根据surv_cutpoint函数确定hsC-NLR的最佳截断值,将患者分为低hsC-NLR组(n=42)和高hsC-NLR组(n=136)。通过Kaplan-Meier法绘制生存曲线,采用log-rank显著性检验计算不同hsC-NLR亚组间生存率差异。采用单因素和多因素Cox回归分析确定影响总生存的独立危险因素。结果最终被纳入本研究的转移性胃癌患者共有178例。hsC-NLR的最佳截断值为2.71,其中低hsC-NLR组有42例,高hsC-NLR组有136例。生存分析结果显示,低hsC-NLR组与高hsC-NLR组的患者3年总生存率分别为20.7%和9.52%,两组之间的差异具有统计学意义(χ^(2)=4.3,P=0.037)。多因素Cox回归分析结果显示,hsC-NLR>2.71(HR:1.632,95%CI:1.035~2.574,P=0.035)、腹膜转移(HR:1.910,95%CI:1.194~3.054,P=0.007)和白蛋白<40 g/L(HR:1.509,95%CI:1.035~2.202,P=0.033)为转移性胃癌患者预后的独立危险因素。结论hsC-NLR可作为转移性胃癌患者的独立预后因素,术前hsC-NLR>2.71提示患者预后不良。

Objective Patients with metastatic gastric cancer(mGC)has a high incidence and poor prognosis.It is known that inflammatory reactions are closely related to tumor development and progression.This study aims to explore the value of high-sensitivity C-reactive protein combined with neutrophil-lymphocyte ratio(hsC-NLR)in predicting the prognosis of patients with mGC who underwent surgery.Method The clinicopathological records of patients who underwent surgery between January 2013 and September 2021 in the Sixth affiliated hospital of Sun Yat-sen University were collected and analyzed retrospectively.According to the surv cutpointfunction,the optimal cut-off value of hsC-NLR was determined,and the patients were divided into low hsC-NLR group(n=42)and high hsC-NLR group(n=136).Overall survival(OS)was analyzed by Kaplan-Meier method.Log-rank test was employed to test the differences in the survival rates between the subgroups.Univariate and multivariate Cox regression analyses were used to identify independent risk factors for OS.Result A total of 178 patients with mGC were finally included in this cohort.The cut-off value of hsC-NLR was 2.71,with 42 cases in the low hsC-NLR group and 136 cases in the high hsC-NLR group.Survival analysis showed that the 3-year OS rates of patients with low hsC-NLR and high hsC-NLR were 20.7%and 9.52%,respectively,and the difference between the two groups was statistically significant(χ^(2)=4.3-P=0.037).Multivariate Cox regression analysis showed that hsC-NLR>2-71(HR:1.632-95%CI:1.035-2.574-P=0.035)-peritoneal metastasis(HR:1.910-95%CI:1.194-3.054-P=0.007)and albumin<40 g/L(HR:1.509-95%CI:1.035-2.202-P=0.033)were independent risk factors for the prognosis of patients with mGC.Conclusion hsC-NLR is an independent prognostic factor for patients with mGC-and a preoperative hsC-NLR greater than 2.71 indicates poor prognosis.