Department of Surgery, National Defense Medical College, Saitama, Japan.
Department of Surgery, National Defense Medical College, Saitama, Japan
In Vivo. 2020 Nov-Dec;34(6):3705-3711. doi: 10.21873/invivo.12218.
To establish a novel systemic inflammatory score (SIS) combined with neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and C-reactive protein/albumin ratio (CAR) and to validate its prognostic value and relation with serum cytokine levels in patients who underwent esophagectomy for esophageal cancer (EC).
Preoperative NLR, PLR, and CAR were evaluated in 102 patients undergoing esophageal resection for EC from 2009 to 2014. Receiver operating characteristic (ROC) curves censored for 5-year survival were plotted to determine the cutoff values of each measure. Each measure was scored 1 if it was above the cutoff value (NLR >3.12, PLR >230, and CAR >0.085) and scored 0 if it was below that. The SIS was defined as the sum of these values and was divided into the two groups: High SIS (SIS=2-3) and low SIS (SIS=0-1). Univariate and multivariate analyses were used to determine the prognostic significance. The area under the ROCs (AUROC) was compared to verify the discriminative power of survival prediction. In addition, we analyzed the relationship between SIS and perioperative serum interleukin (IL)-6 and IL-10 levels.
In the clinicopathological findings, only tumor depth was significantly related to SIS (p=0.004). At 0.732, the AUROC of SIS was the highest (NLR=0.618, PLR=0.545), and CAR=0.712). The high-SIS group had a significantly poorer prognosis than the low-SIS group (p=0.011). SIS was identified as an independent prognostic factor in the multivariate analysis (hazard ratio=1.96, 95% confidence intervaI=1.11-3.41, p=0.020). The preoperative serum interleukin-6 level was significantly low (p=0.046) and postoperative serum interleukin-10 level was significantly high in the high-SIS group (p=0.047).
SIS was a superior predictor of prognosis compared with existing immunoinflammatory markers and closely reflected the fluctuation of peripheral inflammatory cytokines in patients with EC.
建立一种新的全身炎症评分（SIS），结合中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）和 C 反应蛋白/白蛋白比值（CAR），并验证其在接受食管癌（EC）食管切除术的患者中的预后价值及其与血清细胞因子水平的关系。
对 2009 年至 2014 年间接受食管切除术的 102 例 EC 患者进行术前 NLR、PLR 和 CAR 评估。绘制针对 5 年生存的截断值的受试者工作特征（ROC）曲线，以确定每个测量的截断值。如果超过截断值（NLR＞3.12、PLR＞230 和 CAR＞0.085），则每个测量计 1 分，如果低于该值，则计 0 分。SIS 定义为这些值的总和，并分为两组：高 SIS（SIS=2-3）和低 SIS（SIS=0-1）。使用单变量和多变量分析确定预后意义。比较 ROC 的曲线下面积（AUROC）以验证生存预测的区分能力。此外，我们分析了 SIS 与围手术期血清白细胞介素（IL）-6 和 IL-10 水平之间的关系。
在临床病理发现中，只有肿瘤深度与 SIS 显著相关（p=0.004）。SIS 的 AUROC 为 0.732，最高（NLR=0.618，PLR=0.545，CAR=0.712）。高 SIS 组的预后明显差于低 SIS 组（p=0.011）。SIS 在多变量分析中被确定为独立的预后因素（风险比=1.96，95%置信区间=1.11-3.41，p=0.020）。高 SIS 组术前血清白细胞介素-6 水平显著降低（p=0.046），术后血清白细胞介素-10 水平显著升高（p=0.047）。
与现有的免疫炎症标志物相比，SIS 是预后的更好预测指标，并且密切反映了 EC 患者外周炎症细胞因子的波动。
