Cao Longlong, Lu Jun, Lin Jianxian, Zheng Chaohui, Li Ping, Xie Jianwei, Wang Jiabin, Chen Qiyue, Lin Mi, Tu Ruhong, Huang Changming
Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2016 Nov 25;19(11):1252-1257.
To explore the prognostic assessment value of preoperative blood platelet-lymphocyte ratio (PLR) in patients with gastric mixed adenoneuroendocrine carcinoma (gMANEC) treated with radical surgery.
Clinical and pathological data of 84 gMANEC patients who underwent radical resection from 2006 to 2016 in Department of Gastric Surgery, Fujian Medical University Union Hospital were analyzed retrospectively. Receiver operating characteristic (ROC) curve analysis was performed to determine the cutoff value of the PLR for predicting prognosis. The Cox proportional hazards regression model was used to identify prognostic factors of gMANEC.
All the patients underwent D2 lymph node dissection, including 26 cases of distal subtotal gastrectomy and 58 cases of total gastrectomy. The postoperative pathological TNM stage system(pTNM) demonstrated that the patients of stage I(, II(, and III( were 9(10.7%), 14(16.7%), and 61(72.6%) cases, respectively. The median follow-up time was 40(3 to 96) months. The recurrence rate was 41.7%(35/84). The median time to recurrence was 10 (1 to 40) months, and 82.9%(29/35) patients experienced recurrence within the first 2 years after operation. The median overall survival time was 27(3 to 39) month, and the median recurrence-free survival time was 21 (1 to 96) months. The 1-, 3-, and 5-year overall survival(OS) rates were 87.6%, 56.6%, and 47.4%, respectively, and the 1-, 3-, and 5-year recurrence-free survival (RFS) rates were 70.5%, 50.7%, and 44.9%, respectively. The best cutoff value of the PLR for predicting prognosis was 133 through ROC curve, which categorized all the patients into low PLR group (≤133) comprising 28 patients and high PLR group (>133) comprising 56 patients. The tumor recurrence rate was significantly higher in high PLR group (50.0%, 28/56) than that in low PLR group(25.0%, 7/28)(P=0.028). The live metastasis rate was significantly higher in high PLR group(35.7%, 20/56) than that in low PLR group(10.7%, 3/28)(P=0.015). Cox regression analysis showed that only pTNM stage (P=0.003) was independent prognostic factors of OS, while both pTNM stage (P=0.000) and blood PLR (P=0.015) were independent prognostic factors of RFS.
gMANEC patients with high preoperative PLR tend to present recurrence and metastasis, especially to present live metastasis, so they should be kept under surveillance more frequently after surgery.
探讨术前血小板-淋巴细胞比值（PLR）对接受根治性手术治疗的胃混合性腺神经内分泌癌（gMANEC）患者的预后评估价值。
回顾性分析2006年至2016年在福建医科大学附属协和医院胃外科接受根治性切除的84例gMANEC患者的临床和病理资料。采用受试者操作特征（ROC）曲线分析确定PLR预测预后的临界值。采用Cox比例风险回归模型确定gMANEC的预后因素。
所有患者均行D2淋巴结清扫，其中远端胃次全切除术26例，全胃切除术58例。术后病理TNM分期系统（pTNM）显示，Ⅰ期、Ⅱ期和Ⅲ期患者分别为9例（10.7%）、14例（16.7%）和61例（72.6%）。中位随访时间为40（3至96）个月。复发率为41.7%（35/84）。中位复发时间为10（1至40）个月，82.9%（29/35）的患者在术后2年内复发。中位总生存时间为27（3至39）个月，中位无复发生存时间为21（1至96）个月。1年、3年和5年总生存率分别为87.6%、56.6%和47.4%，1年、3年和5年无复发生存率分别为70.5%、50.7%和44.9%。通过ROC曲线确定PLR预测预后的最佳临界值为133，将所有患者分为低PLR组（≤133）28例和高PLR组（>133）56例。高PLR组的肿瘤复发率（50.0%，28/56）显著高于低PLR组（25.0%，7/28）（P=0.028）。高PLR组的肝转移率（35.7%，20/56）显著高于低PLR组（10.7%，3/28）（P=0.015）。Cox回归分析显示，仅pTNM分期（P=0.003）是总生存的独立预后因素，而pTNM分期（P=0.000）和血液PLR（P=0.015）均是无复发生存率的独立预后因素。
术前PLR高的gMANEC患者容易出现复发和转移，尤其是肝转移，因此术后应更频繁地进行监测。
