NLR和PLR对胰腺癌患者术后生存的影响

Effects of NLR and PLR on postoperative survival of patients with pancreatic cancer

目的研究术前胰腺癌患者中性粒细胞与淋巴细胞数比值(NLR)和血小板与淋巴细胞比值(PLR)对术后生存的影响。方法回顾性分析2018年1月至2021年1月在资阳市第一人民医院行胰腺手术的50例胰腺癌患者的临床资料,其中男性34例,女性16例,年龄(60±5)岁。用术前血细胞分析相关数值计算出NLR和PLR,根据NLR、PLR的受试者工作特征曲线取约登指数最大切点为临界点,确定NLR和PLR的临界值分别为3.69和188,依据上述截断值,将患者分组:NLR>3.69的患者纳入高NLR组(n=23),NLR≤3.69的患者纳入低NLR组(n=27),PLR>188的患者纳入高PLR组(n=17),PLR≤188的患者纳入低PLR组(n=33)。术后采用门诊复诊和电话询问的方式随访患者的生存情况。采用Kaplan-Meier法进行生存分析,生存率比较采用log-rank检验。结果50例胰腺癌患者中,21例患者实施了根治性手术,29例患者实施了姑息性手术,术后中位总生存期为15个月。高NLR组和低NLR组患者的肿瘤分化程度、肿瘤部位间差异具有统计学意义(均P<0.05)。高PLR组与低PLR组患者的肿瘤位置、肿瘤分化程度间差异具有统计学意义(均P<0.05)。高NLR组胰腺癌患者术后1、2、3年的累积生存率分别为61.2%、32.8%和15.2%,低NLR组术后1、2、3年的累积生存率分别为79.5%、52.1%和23.6%,高NLR组和低NLR组患者术后累积生存率比较,差异具有统计学意义(P=0.015)。高PLR组胰腺癌患者术后1、2、3年的累积生存率分别为63.4%、25.1%和17.2%,低PLR组术后1、2、3年的累积生存率分别为80.3%、46.0%和25.8%,高PLR组和低PLR组患者术后累积生存率比较,差异具有统计学意义(P=0.011)。结论术前NLR和PLR与胰腺癌患者术后生存相关,NLR>3.69和PLR>188的胰腺癌患者预后较差。

Objective To study the impact of preoperative neutrophil-to-lymphocyte ratio(NLR)and platelet to lymphocyte ratio(PLR)on postoperative survival prognosis in patients with pancreatic cancer.Methods The clinical data of 50 pancreatic cancer patients who underwent pancreatic surgery in Ziyang First People's Hospital from January 2018 to January 2021 were retrospectively analyzed,including 34 males and 16 females,aged(60±5)years old.The NLR and PLR were calculated using the relevant values of preoperative blood cell analysis.Based on the receiver operating characteristic curves of NLR and PLR,the maximum cut-off point of the Youden index was taken as the critical point.The critical values of NLR and PLR were determined to be 3.69 and 188 respectively,based on which,patients were divided into groups:patients with NLR>3.69 were included in the high NLR group(n=23),patients with NLR≤3.69 were included in the low NLR group(n=27),and patients with PLR>188 were included in the high PLR group(n=17),patients with PLR≤188 were included in the low PLR group(n=33).After surgery,the patient's survival status was followed up through outpatient follow-up visits and telephone inquiries.Survival analysis was performed using the Kaplan-Meier method,and log-rank test was used to compare survival rates.Results Among 50 patients with pancreatic cancer,21 patients underwent radical surgery and 29 patients underwent palliative surgery.The median overall survival after surgery was 15 months.There were statistically significant differences in tumor differentiation degree and tumor location between patients in the high NLR group and the low NLR group(all P<0.05).There were also statistically significant differences in tumor location and tumor differentiation between the high PLR group and the low PLR group(all P<0.05).The cumulative survival rates of pancreatic cancer patients in the high NLR group at 1,2,and 3 years after surgery were 61.2%,32.8%and 15.2%,respectively.The cumulative survival rates at 1,2,and 3 years in the low NLR group were 79.5%,52.1%and 23.6%,respectively.Comparing the postoperative cumulative survival rates of patients between the high NLR group and the low NLR group,the difference was statistically significant(P=0.015).The cumulative survival rates of pancreatic cancer patients in the high PLR group at 1,2,and 3 years after surgery were 63.4%,25.1%and 17.2%,respectively.The cumulative survival rates at 1,2 and 3 years in the low PLR group were 80.3%,46.0%,and 25.8%,respectively.Comparing the postoperative cumulative survival rates of patients between the high PLR group and the low PLR group,the difference was statistically significant(P=0.011).Conclusion Preoperative NLR and PLR are related to postoperative survival of pancreatic cancer patients.Pancreatic cancer patients with NLR>3.69 and PLR>188 have poor prognosis.