PLR、NLR、CRP联合评估进展期胃癌腹膜腔转移的价值研究

Study on the value of PLR,NLR and CRP in evaluating peritoneal metastasis of advanced gastric cancer

目的探讨血小板计数/淋巴细胞计数(platelet count/lymphocyte count,PLR)、中性粒细胞计数/淋巴细胞计数(neutrophil count/lymphocyte count,NLR)、C反应蛋白(C-reactive protein,CRP)评估进展期胃癌腹膜腔转移的价值。方法回顾性选取江苏省徐州市肿瘤医院进展期胃癌患者124例,根据是出现腹膜腔转移分为腹腔转移组36例、非腹腔转移组88例。比较2组临床资料、病理学参数及CRP、PLR、NLR,Logistic分析进展期胃癌腹膜腔转移影响因素,构建Logistic回归模型,受试者工作特征(receiver operating characteristics,ROC)曲线评估其对腹膜腔转移的预测价值。结果腹腔转移组肿瘤直径大于非腹腔转移组,浸润深度、TNM分期及PLR、NLR、CRP水平高于腹腔转移组,组织学分化程度低于非腹腔转移组(P<0.05);排除PLR、NLR和CRP之外的混杂因素肿瘤大小、浸润深度、TNM分期和组织学分化,建立Logistic模型,对其行多因素分析,显示PLR、NLR和CRP是进展期胃癌腹膜腔转移的危险因素(P<0.05);构建风险预测模型:logit(p)=PLR×1.416+NLR×1.149+CRP×1.088;模型预测价值:ROC分析,logit(p)>0.5时,AUC值为0.755,χ^(2)为10.212,诊断敏感度为80.95%,特异度为61.64%。结论进展期胃癌腹膜腔转移与PLR、NLR、CRP水平及相关临床特征相关,根据PLR、NLR、CRP和相关临床因素构建的预测模型对其具有较高预测价值,可为临床决策提供依据。

Objective To investigate the value of platelet to lymphocyte ratio(PLR),neutrophil tolymphocyte ratio(NLR)and C-reactive protein(CRP)in evaluating peritoneal metastasis of advanced gastric cancer.Methods A total of 124 patients with advanced gastric cancer in Xuzhou Cancer Hospital were retrospectively selected and divided into peritoneal metastasis group(n=36)and non-peritoneal metastasis group(n=88)according to the occurrence of peritoneal metastasis.The clinical data,pathological parameters,CRP,PLR,NLR were compared between the two groups,to analyze the influencing factors of peritoneal metastasis of advanced gastric cancer.Logistic regression model was constructed,and receiver operating characteristic(ROC)curve was used to evaluate its predictive value for peritoneal metastasis.Results The tumor diameter of the abdominal metastasis group was higher than that of the non-abdominal metastasis group,the invasion depth,TNM stage,and PLR,NLR,CRP levels were higher than those of the abdominal metastasis group,and the degree of histological differentiation was lower than that of the non-abdominal metastasis group(P<0.05).After excluding confounding factors such as tumor size,invasion depth,TNM stage and histological differentiation,the Logistic model was established and multivariate analysis was performed.PLR,NLR and CRP were found to be risk factors for peritoneal metastasis in advanced gastric cancer(P<0.05).The risk prediction model was constructed:logit(p)=PLR×1.416+NLR×1.149+CRP×1.088.As for predictive value of the model,when logit(p)>0.5,the AUC value was 0.755,χ^(2) was 10.212,the diagnostic sensitivity was 80.95%,and the specificity was 61.64%.Conclusion Peritoneal metastasis of advanced gastric cancer is correlated with the levels of PLR,NLR and CRP and related clinical characteristics.The predictive model based on PLR,NLR,CRP and related clinical factors has high predictive value,and can provide a basis for clinical decision-making.