术前CT结合NLR、PLR、CAR对cN0期胃癌患者术后淋巴结转移的预测价值

Predictive Value of Preoperative CT Combined with NLR,PLR and CAR for Postoperative Lymph Node Metastasis in Patients with cN0 Gastric Cancer

目的:探讨术前CT诊断结合中性粒细胞和淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)、血小板和淋巴细胞比值(platelet to lymphocyte ratio,PLR)、C反应蛋白和白蛋白比值(C-reactive protein to albumin ratio,CAR)等术前系统性炎症指标对cN0期胃癌患者术后淋巴结转移的预测价值。方法:回顾性收集我院2021年1月至2023年12月期间术前经CT临床诊断为cN0期胃癌患者210例作为研究对象,收集患者的临床资料及术前系统性炎症指标,全部患者接受胃癌根治术治疗,并按照术后病理分为术后无淋巴结转移组(pN0)和淋巴结转移组(pN+),比较两组NLR、PLR、CAR指标之间的差异,并采用Logistic回归模型筛选术前CT诊断cN0期胃癌患者发生淋巴结转移的独立危险因素。结果:210例cN0期胃癌患者中,术后病理诊断无淋巴结转移(pN0)107例(50.95%)、淋巴结转移(pN+)103例(49.05%)。pN+组胃癌患者术前中性粒细胞计数、血小板计数、C反应蛋白、NLR、CAR总体水平明显高于pN0组患者,差异均有统计学意义(均P<0.05)。单因素及多因素Logistic回归分析显示:肿瘤最大径≥3.0 cm(OR=2.175)、pT分期为T3~T4(OR=2.201)、NLR≥2.19(OR=1.922)、CAR≥0.12(OR=3.631)是cN0期胃癌患者术后淋巴结转移的独立危险因素,差异均有统计学意义(均P<0.05)。结论:术前高NLR和CAR水平是术前CT诊断的cN0期胃癌患者术后淋巴结转移的独立危险因素。

Objective:To explore the predictive value of preoperative CT combined with preoperative systemic inflammatory markers such as neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR)and C-reactive protein to albumin ratio(CAR)for postoperative lymph node metastasis in patients with cN0 gastric cancer.Methods:We retrospectively collected 210 cases of cN0 stage gastric cancer by preoperative CT diagnosis in our hospital from January 2021 to December 2023 as subjects.The clinical data and preoperative systemic inflammatory markers were collected.All patients underwent radical treatment for gastric cancer,and were assigned to the non-lymph node metastasis group(pN0)and the lymph node metastasis group(pN+)according to postoperative pathology.The differences in NLR,PLR and CAR were compared be-tween two groups,and the logistic regression model was used to screen the independent risk factors of lymph node metastasis in patients with cN0 gastric cancer.Results:Among the 210 cN0 gastric cancer patients,there were 107(50.95%)pN0 cases and 103(49.05%)pN+cases diagnosed by postoperative pathology.The overall levels of preoperative neutrophil count,platelet count,C-reactive protein,NLR and CAR in the pN+group were significantly higher than those in the pN0 group,and the differences were statistically significant(all P<0.05).Univariate and multivariate logistic regression analyses showed that tumor maximum diameter≥3.0 cm(OR=2.175),pT stage T3-T4(OR=2.201),NLR≥2.19(OR=1.922)and CAR≥0.12(OR=3.631)were independent risk factors for post-operative lymph node metastasis in cN0 stage gastric cancer patients,and the differences were statistically significant(all P<0.05).Conclusion:Preoperative high NLR and CAR levels are independent risk factors for postoperative lymph node metastasis in cN0 stage gastric cancer patients diagnosed by preoperative CT.