[术前中性粒细胞与淋巴细胞比值对75岁以上老年胃癌患者的预后价值]

[Prognostic value of preoperative neutrophil-to-lymphocyte ratio in the elderly patients over 75 years old with gastric cancer].

作者信息

Zhang Xing, Li Sen, Guo Zhongwu, Xue Yingwei

机构信息

Department of Gastrointestinal Surgery, the Tumour Hospital of Harbin Medical University, Harbin 150081, China.

出版信息

Zhonghua Wei Chang Wai Ke Za Zhi. 2016 May;19(5):526-9.

PMID:27215519

Abstract

OBJECTIVE

To investigate the clinical implication of preoperative neutrophil-to-lymphocyte ratio (NLR), and association of NLR with the prognosis of the elderly patients over 75 years old with primary gastric cancer.

METHODS

Clinical data of 160 patients (≥75 years) with gastric cancer undergoing gastrectomy in Department of Gastrointestinal Surgery, the Tumour Hsopital of Harbin Medical University form January 2007 to December 2010 were retrospectively analyzed. Preoperative neutrophil and lymphocyte count was measured and NLR was calculated. The cut-off value of NLR to predict the survival was obtained from the receiver operating characteristic(ROC) curve. Patients were divided into two groups based on cut-off value. Clinicopathological features were compared between two groups using Chi-square test or Fisher exact test. Cox proportional hazard model was used to analyze risk factors associated with survival.

RESULTS

The cut-off value of NLR was 1.83 with 0.709 of sensitivity and 0.562 of specificity. A total of 54 patients with NLR<1.83 belonged to NLR-0 group, and 106 patients with NLR≥1.83 belonged to NLR-1 group. As compared to NLR-0 group, patients in NLR-1 group had significantly higher proportion in maximum tumor size ≥ 50 mm [66.0%(70/106) vs. 42.6%(23/54), P=0.004], serosal invasion [75.5%(80/106) vs. 57.4%(31/54), P=0.029], positive lymph node metastasis [83.0% (88/106) vs. 55.6%(30/54), P=0.001] and TNM stage III( [79.2%(84/106) vs. 61.1%(33/54), P=0.013]. The median survival of NLR-0 and NLR-1 group was 1 209 days and 587 days respectively, with significant difference(P=0.001). Multivariate analysis showed that NLR≥1.83(HR=0.530, 95% CI: 0.332 to 0.846, P=0.008), serosal invasion (HR=0.570, 95% CI: 0.332 to 0.979, P=0.042), and lymph node metastasis(HR=0.475, 95% CI: 0.462 to 1.685, P=0.033) were independent risk factors of poor prognosis(all P<0.05).

CONCLUSION

Preoperative higher NLR value in the elderly patients over 75 years old with primary gastric cancer indicates larger tumor size, severe serous invasion, more lymph node metastasis, later TNM staging, and poorer prognosis.

摘要

目的

探讨术前中性粒细胞与淋巴细胞比值（NLR）的临床意义，以及NLR与75岁以上老年原发性胃癌患者预后的关系。

方法

回顾性分析2007年1月至2010年12月在哈尔滨医科大学附属肿瘤医院胃肠外科接受胃癌根治术的160例年龄≥75岁胃癌患者的临床资料。检测术前中性粒细胞和淋巴细胞计数并计算NLR。通过受试者工作特征（ROC）曲线获得预测生存的NLR临界值。根据临界值将患者分为两组。采用卡方检验或Fisher确切检验比较两组的临床病理特征。采用Cox比例风险模型分析与生存相关的危险因素。

结果

NLR的临界值为1.83，灵敏度为0.709，特异度为0.562。NLR<1.83的54例患者为NLR-0组，NLR≥1.83的106例患者为NLR-1组。与NLR-0组相比，NLR-1组患者最大肿瘤直径≥50 mm的比例显著更高[66.0%（70/106）对42.6%（23/54），P = 0.004]，浆膜侵犯[75.5%（80/106）对57.4%（31/54），P = 0.029]，阳性淋巴结转移[83.0%（88/106）对55.6%（30/54），P = 0.001]及TNM分期III期[79.2%（84/106）对61.1%（33/54），P = 0.013]。NLR-0组和NLR-1组的中位生存期分别为1209天和587天，差异有统计学意义（P = 0.001）。多因素分析显示，NLR≥1.83（HR = 0.530，95%CI：0.332至0.846，P = 0.008）、浆膜侵犯（HR = 0.570，95%CI：0.332至0.979，P = 0.042）和淋巴结转移（HR = 0.475，95%CI：0.462至1.685，P = 0.033）是预后不良的独立危险因素（均P<0.05）。