系统免疫炎症指数和血小板/淋巴细胞比值与胃癌患者术后预后的关系

Relationship between systemic immune-inflammation index or platelet to lymphocyte ratio and postoperative prognosis of patients with gastric cancer

目的分析系统免疫炎症指数(SII)和血小板/淋巴细胞比值(PLR)与胃癌患者术后预后的关系,为临床评估患者预后提供参考。方法回顾性分析2015年1月至2016年12月南通市肿瘤医院收治的106例行手术治疗的胃癌患者的临床资料,根据患者5年生存情况分为预后良好组(存活,45例)与预后不良组(死亡,61例),检测患者血小板计数、中性粒细胞计数及淋巴细胞计数,计算SII水平、PLR值,根据SII水平分为SII高表达组(SII≥412.30,48例)及SII低表达组(SII<412.30,58例);根据PLR水平分为PLR高表达组(PLR≥125,39例)及PLR低表达组(PLR<125,67例)。分析胃癌患者临床特征与术前SII、PLR水平的关系;统计预后良好组与预后不良组患者临床特征,通过COX回归模型分析胃癌患者术后预后的影响因素。结果SII高表达组、PLR高表达组肿瘤最大径≥4 cm、T分期T3+T4、远处转移、胃下部肿瘤、分化程度为低分化、癌胚抗原(CEA)>5 ng/mL、糖类抗原199(CA199)≥37 U/mL患者占比均分别显著高于SII低表达组、PLR低表达组;预后良好组年龄≥60岁、肿瘤最大径≥4 cm、T分期T3+T4、远处转移、胃下部肿瘤、分化程度为低分化、CEA>5 ng/mL、CA199≥37 U/mL、SII≥412.30、PLR≥125患者占比均显著低于预后不良组;COX回归模型分析显示,年龄≥60岁、肿瘤最大径≥4 cm、T分期T3+T4、远处转移、胃下部肿瘤、分化程度为低分化、CEA>5 ng/mL、CA199≥37 U/mL、SII≥412.30、PLR≥125均为胃癌患者术后预后的独立危险因素(HR=1.451、1.356、2.451、1.549、1.285、1.196、1.795、1.426、1.356、1.245,均P<0.05)。结论SII、PLR水平与胃癌患者术后预后密切相关,SII、PLR高表达是胃癌患者术后预后的独立危险因素,早期监测SII、PLR水平变化有助于评估胃癌患者术后预后情况。

Objective To analyze the relationship between systemic immune-inflammation index(SII)or platelet to lymphocyte ratio(PLR)and postoperative prognosis of patients with gastric cancer,provide reference for clinical evaluation of patients’prognosis.Methods The retrospective analysis of the clinical data of 106 patients with gastric cancer who treated with surgical treatment in Nantong Tumor Hospital from January 2015 to December 2016 was conducted,the patients were divided into the good prognosis group(in survival,45 cases)and the poor prognosis group(in death,61 cases)according to their 5-year survival,the platelet count,neutrophil count and lymphocyte count were detected,and the SII level,PLR ratio were calculated.According to the level of SII,they were divided into the SII high expression group(SII≥412.30,48 cases)and the SII low expression group(SII<412.30,58 cases);according to the level of PLR ratio,they were divided into the high expression group of PLR(PLR≥125,39 cases)and the low expression group of PLR(PLR<125,67 cases).The relationship between the clinical characteristics of gastric cancer patients and preoperative SII or PLR levels were analysed;the clinical characteristics of patients in the good prognosis group and the poor prognosis group were counted;the influencing factors of postoperative prognosis of gastric cancer patients was analysed by the COX regression model.Results The proportion of patients with the largest diameter of tumor≥4 cm,T stage T3+T4,distant metastasis,subgastric tumor,the degree of differentiation with low differentiation,carcinoembryonic antigen(CEA)>5 ng/mL,carbohydrate antigen 199(CA199)≥37 U/m L in the SII high expression group and the high expression group of PLR were significantly higher than those in the SII low expression group and the low expression group of PLR,respectively;the proportion of patients with age≥60 years,the largest diameter of tumor≥4 cm,T stage T3+T4,distant metastasis,subgastric tumor,the degree of differentiation with low differentiation,CEA>5 ng/mL,CA199≥37 U/mL,SII≥412.30,PLR ratio≥125 in the good prognosis group were significantly lower than those in the poor prognosis group;the result of the COX regression model analysis showed that,age≥60 years,maximum tumor diameter≥4 cm,T stage T3+T4,distant metastasis,subgastric tumor,the degree of differentiation with low differentiation,CEA>5 ng/mL,CA199≥37 U/mL,SII≥412.30,PLR≥125 were all the independent risk factors for postoperative prognosis of gastric cancer patients(HR=1.451,1.356,2.451,1.549,1.285,1.196,1.795,1.426,1.356,1.245,all P<0.05).Conclusion SII and PLR levels are closely related to the postoperative prognosis of patients with gastric cancer,high expression of SII and PLR are the independent risk factor for the postoperative prognosis of patients with gastric cancer,early monitoring of SII and PLR levels is helpful to evaluate the postoperative prognosis of patients with gastric cancer.