Division of Surgical Oncology, Department of General Surgery, Vicente Sotto Memorial Medical Center, Cebu, Philippines.
Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea; Pancreatobiliary Cancer Center, Yonsei Cancer Center, Severance Hospital, Seoul, South Korea.
J Surg Res. 2019 Aug;240:17-29. doi: 10.1016/j.jss.2019.02.043. Epub 2019 Mar 22.
We designed a clinical application of glucose to lymphocyte ratio (GLR) as it might be a sensitive parameter to determine the glucose metabolism and behavior of the cancer (i.e., its aggressiveness), and the immunologic status of a patient with cancer. Thus, we investigated the association of GLR with the overall survival (OS) and disease-free survival (DFS) of patients with T2 gallbladder (GB) cancer after curative-intent surgery.
The medical records of patients with T2 GB cancer who underwent surgery were retrospectively reviewed. The clinicopathologic characteristics, preoperative complete blood counts, fasting blood glucose, albumin, cholesterol, and follow-up information were collected.
A total of 197 patients were included in the study. In multivariate analysis, high GLR (>69.3) was associated with poor OS (HR = 15.249, 95% CI: 4.090-56.849, P = 0.0001) along with R1 status (HR = 1.755, 95% CI: 0.033-0.910, P = 0.033), >3 metastatic lymph nodes (HR = 2.809, 95% CI: 1.403-5.625; P = 0.004), and lymphovascular invasion (HR = 8.041, 95% CI: 2.881-22.442; P = 0.0001). Moreover, high GLR (HR = 3.666, 95% CI: 1.145-11.737, P = 0.029), adjuvant chemotherapy (HR = 6.306, 95% CI: 1.921-20.699; P = 0.002), lymphovascular invasion (HR = 5.464, 95% CI: 1.783-16.746; P = 0.003), and high-grade tumor (HR = 2.143, 95% CI: 1.042-4.407; P = 0.038) were independently associated with DFS.
Preoperative GLR is an independent predictor of OS and DFS in T2 GB cancer. Further studies are required to validate these findings.
我们设计了一种葡萄糖与淋巴细胞比值（GLR）的临床应用，因为它可能是一个敏感的参数，可以确定癌症的葡萄糖代谢和行为（即其侵袭性）以及癌症患者的免疫状态。因此，我们研究了 GLR 与 T2 胆囊（GB）癌患者根治术后总生存期（OS）和无病生存期（DFS）的关系。
回顾性分析了接受手术治疗的 T2GB 癌患者的病历。收集了临床病理特征、术前全血细胞计数、空腹血糖、白蛋白、胆固醇和随访信息。
共纳入 197 例患者。多因素分析显示，高 GLR（>69.3）与 OS 不良相关（HR=15.249，95%CI：4.090-56.849，P=0.0001），同时伴有 R1 状态（HR=1.755，95%CI：0.033-0.910，P=0.033）、>3 个转移性淋巴结（HR=2.809，95%CI：1.403-5.625；P=0.004）和血管淋巴管侵犯（HR=8.041，95%CI：2.881-22.442；P=0.0001）。此外，高 GLR（HR=3.666，95%CI：1.145-11.737，P=0.029）、辅助化疗（HR=6.306，95%CI：1.921-20.699；P=0.002）、血管淋巴管侵犯（HR=5.464，95%CI：1.783-16.746；P=0.003）和高级别肿瘤（HR=2.143，95%CI：1.042-4.407；P=0.038）与 DFS 独立相关。
术前 GLR 是 T2GB 癌患者 OS 和 DFS 的独立预测因子。需要进一步的研究来验证这些发现。
