术前乳酸脱氢酶和HALP的联合评分对Ⅲ期胃癌患者预后的影响

Effect of combined preoperative lactate dehydrogenase and HALP scores on the prognosis of patients with stage Ⅲ gastric cancer

目的 探讨术前乳酸脱氢酶(LDH)和血红蛋白、白蛋白、淋巴细胞、血小板(HALP)的联合评分(L-HALP)对接受根治性胃癌切除术并行辅助化疗的Ⅲ期胃癌患者预后的影响,并建立列线图预测模型。方法 回顾性分析2015年1月—2018年12月于河北省人民医院行D2胃癌根治术并接受辅助化疗的176例Ⅲ期胃癌患者的临床病理资料,收集患者年龄、性别、肿瘤部位、肿瘤大小、组织学分级、pTNM分期、淋巴血管侵犯、神经周围侵犯、辅助化疗方案等,术前1周外周血LDH、Hb、ALB、淋巴细胞计数、PLT等,并计算HALP。对患者进行电话、门诊、住院等形式随访,随访截止时间为2022年3月。LDH采用本院正常上限值,应用X-tile软件得到HALP的最佳截断值,综合LDH水平和HALP建立L-HALP评分,分析其与患者临床病理特征及预后的关系。结果 患者中位总生存时间为46个月,1年、3年和5年生存率分别为88.1%、57.7%、41.4%。高LDH组和低HALP组患者OS均显著低于低LDH组和高HALP组(P<0.05)。高风险与低风险组OS比较,差异有统计学意义(P<0.001)。高LDH(≥250 U/L)和低HALP(<25.8)患者的L-HALP评分为2分,低LDH(<250 U/L)和高HALP(≥25.8)为0分,两者均高或者均低为1分。高L-HALP评分患者与手术年龄较大、TNM分期较晚、化疗周期短有关(P<0.05)。单因素分析结果显示,LDH、HALP、L-HALP评分、TNM分期、组织学分级、化疗周期、淋巴血管侵犯与OS相关(均P<0.05)。在多因素分析中,L-HALP评分、TNM分期、组织学分级是影响总生存期(OS)的独立预后因素。基于L-HALP评分与其他独立预测因素构建的Nomogram具有良好的预测效果,其一致性指数(C-index)为0.705。结论 术前L-HALP是影响行根治性切除Ⅲ期胃癌患者预后的独立因素,基于L-HALP评分的列线图模型具有较好的预后性能。

Objective To investigate the effect of combined preoperative lactate dehydrogenase and HALP scores(L-HALP)on the prognosis of stage Ⅲ patients undergoing radical gastrectomy with adjuvant chemotherapy,and develop a line graph prediction model.Methods The clinicopathologic data of 176 patients with stage Ⅲ gastric cancer who underwent D2 radical gastrectomy and received adjuvant chemotherapy in Hebei Provincial People′s Hospital from January 2015 to December 2018 were retrospectively analyzed.Age,gender,tumor site,tumor size,histological grade,pTNM stage,lymphatic vascular invasion,peripheral nerve invasion,and adjuvant chemotherapy were collected.Peripheral blood lactate dehydrogenase,Hb,ALB,lymphocyte count,PLT,etc.,and HALP were calculated 1 week before surgery.The patients were followed up by telephone,outpatient and inpatient,and the follow-up period was March 2022.The optimal cut-off value of HALP was obtained using the normal upper limit of LDH in our hospital and the X-tile software.The-HALP score was established based on the combination of LDH level and HALP,and the relationship between LDH level and the clinicpathological features and prognosis of patients was analyzed.Results The median overall survival time of patients was 46 months,with 1-,3-,and 5-year survival rates of 88.1%,57.7%,and 41.4%,respectively.Patients with high LDH(≥250 U/L)and low HALP(<25.8)had an L-HALP score of 2,low LDH(<250 U/L)and high HALP(≥25.8)had a score of 0,and both were high or low with a score of 1.Patients with high L-HALP scores were associated with older age at surgery,later TNM stage,and shorter chemotherapy cycles.In the multifactorial analysis,L-HALP score,TNM stage,and histological grade were independent prognostic factors affecting overall survival(OS).The Nomogram constructed based on the L-HALP score and other independent predictors had good predictive effect with a concordance index(C-index)of 0.705.Conclusion Preoperative L-HALP is an independent factor affecting the prognosis of patients undergoing radical resection for stage III gastric cancer,and the columnar line graph model based on L-HALP scores has a better prognostic performance.