CTC联合NLR预测可切除老年原发性胃癌患者术后辅助化疗疗效和预后的临床研究

Clinical study of CTC combined with NLR to predict the efficacy and prognosis of postoperative adjuvant chemotherapy in senile patients with resectable primary gastric cancer

目的探讨循环肿瘤细胞(CTC)联合中性粒细胞计数和淋巴细胞计数比(NLR)在可切除老年原发性胃癌患者术后辅助化疗疗效和预后中的预测效果。方法选择江苏省肿瘤医院2017年12月至2020年12月可切除老年原发性胃癌患者93例为观察组;选择同期健康体检志愿者51例血清标本为对照组。观察组患者均连续完成6个月化疗,根据化疗疗效分为化疗不敏感组及化疗敏感组,比较两组CTC和NLR水平并分析其在辅助化疗疗效中的诊断效能;Kaplan-meier法绘制不同CTC和NLR表达患者的总生存时间(OS)和无进展生存时间(PFS)曲线,生存差异行Log-rank检验。结果观察组NLR高于对照组[2.90(2.15,4.20)vs.1.89(1.50,2.42),Z=-6.382,P<0.05];93例患者辅助化疗后不敏感组32例,化疗敏感组61例;化疗不敏感组患者NLR及CTC水平高于化疗敏感组(P<0.05)。受试者工作特征曲线(ROC)分析,NLR诊断化疗疗效的曲线下面积(AUC)为0.714(95%CI:0.612~0.815),当截断值为2.24时,灵敏度高达100%,特异度为41.0%;当NLR联合CTC时,AUC=0.806(95%CI:0.709~0.903),灵敏度78.14%,特异度为75.43%。仅NLR与患者年龄有关(P<0.05)。CTC高表达患者中位OS和中位PFS为22.0个月和15.0个月,均低于CTC低表达患者的27.0个月和20.0个月,差异均有统计学意义(P<0.05)。NLR高表达患者中位OS和中位PFS为22.0个月和14.0个月,均低于NLR低表达患者的30.0个月和19.0个月,差异均有统计学意义(P<0.05)。结论NLR联合CTC可预测患者辅助化疗疗效及预后,作为判断患者治疗效果及预后的潜在指标。

Objective To investigate the predictive effect of circulating tumor cell(CTC)combined with neutrophil to lymphocyte count ratio(NLR)in postoperative adjuvant chemotherapy in senile patients with resectable primary gastric cancer.Methods Ninety-three elderly patients with resectable primary gastric cancer from December 2017 to December 2020 were selected as the observation group.Serum samples from 51 healthy volunteers were selected as control group.Observation group was divided into chemotherapy insensitive group and chemotherapy sensitive group according to chemotherapy efficacy.CTC and NLR levels of the two groups were compared and their diagnostic efficacy in adjuvant chemotherapy efficacy was analyzed.Overall survival(OS)and progression-free survival(PFS)curves of patients with different CTC and NLR expression were plotted by Kaplan-meier method,and survival differences were tested by Log-rank.Results The NLR of observation group was higher than that of control group[2.90(2.15,4.20)vs.1.89(1.50,2.42),Z=-6.382,P<0.05].Of the 93 patients,32 were insensitive group and 61 were sensitive group after adjuvant chemotherapy.The levels of NLR and CTC in chemotherapy insensitive group were higher than those in chemotherapy sensitive group(P<0.05).Receiver operating characteristic curve(ROC)analysis showed that the area under the curve(AUC)of NLR was 0.714(95%CI:0.612-0.815).When the cut-off value was 2.24,the sensitivity was up to 100%and the specificity was 41.0%.When NLR combined with CTC,AUC=0.806(95%CI:0.709-0.903),sensitivity 78.14%,specificity 75.43%.Only NLR was associated with patient age(P<0.05).The median OS and PFS in patients with high CTC expression were 22.0 months and 15.0 months,both lower than 27.0 months and 20.0 months in patients with low CTC expression,and the differences were statistically significant(P<0.05).The median OS and PFS in patients with high NLR expression were 22.0 months and 14.0 months,both lower than those in patients with low NLR expression(30.0 months and 19.0 months),and the differences were statistically significant(P<0.05).Conclusion NLR combined with CTC can predict the efficacy and prognosis of adjuvant chemotherapy,and can be used as a potential indicator to judge the therapeutic effect and prognosis of patients.