Wu Cai-Xia, Rao Ding-Yu, Sang Cheng-Peng, Zhu Shen-Yu, Gu Liang, Wu Yan-Yang, Wang Jian-Feng, Shi Hua-Qiu, Wang Xiang-Cai, Tang Zhi-Xian
First Clinical Medical College, The Gannan Medical University, Ganzhou, China.
Ganzhou Key Lab of Brain Injury & Brain Protection, Ganzhou, China.
J Gastrointest Oncol. 2021 Dec;12(6):2675-2684. doi: 10.21037/jgo-21-812.
This study investigated the predictive value of peripheral inflammatory indices, including neutrophil count, lymphocyte count, platelet count, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR), in anastomotic leakage during elective esophageal surgery.
This retrospective study included all patients who underwent esophagectomy for esophageal squamous cell carcinoma from 2016 to 2020 in our institution. The peripheral blood inflammatory indices were obtained on preoperative days 1-7 (PRD 1-7), and postoperative days 1-3 (POD 1-3) and 4-7 (POD 4-7). Univariate, multivariate logistic, and receiver operating characteristic curve analyses were conducted to evaluate the diagnostic value of these peripheral blood inflammatory indices.
A total of 198 patients were included in the study, and 25 (13%) patients experienced anastomotic leakage. Multivariate analyses identified diet, neutrophil count, and PLR on POD 1-3, and NLR on POD 4-7 as independent factors associated with anastomotic leakage. Using the receiver operating characteristic curve, the variable with the best area under curve was a neutrophil cutoff count of 4.1 [0.737; 95% CI: 0.639-0.835], with a sensitivity and specificity of 60.0% and 66.5%, respectively. This was followed by an NLR cutoff value of 9.5 on POD 4-7 (0.628; 95% CI: 0.505-0.752) and a cutoff PLR value of 220.1 on POD 1-3 (0.643; 95% CI: 0.536-0.750). Diet showed a poor result on the receiver operating characteristic curve analysis.
Neutrophil count and PLR on POD 1-3 and NLR on POD 4-7 were shown to have predictive value for anastomotic leakage in elective esophageal surgery.
本研究调查了包括中性粒细胞计数、淋巴细胞计数、血小板计数、中性粒细胞与淋巴细胞比值（NLR）以及血小板与淋巴细胞比值（PLR）在内的外周炎症指标在择期食管手术吻合口漏中的预测价值。
本回顾性研究纳入了2016年至2020年在我院接受食管鳞状细胞癌食管切除术的所有患者。在术前第1 - 7天（PRD 1 - 7）、术后第1 - 3天（POD 1 - 3）和第4 - 7天（POD 4 - 7）获取外周血炎症指标。进行单因素、多因素逻辑回归及受试者工作特征曲线分析，以评估这些外周血炎症指标的诊断价值。
本研究共纳入198例患者，其中25例（13%）发生吻合口漏。多因素分析确定饮食、POD 1 - 3时的中性粒细胞计数和PLR以及POD 4 - 7时的NLR为与吻合口漏相关的独立因素。使用受试者工作特征曲线，曲线下面积最佳的变量是中性粒细胞临界计数为4.1 [0.737；95%可信区间：0.639 - 0.835]，敏感性和特异性分别为60.0%和66.5%。其次是POD 4 - 7时NLR临界值为9.5（0.628；95%可信区间：0.505 - 0.752）以及POD 1 - 3时PLR临界值为220.1（0.643；95%可信区间：0.536 - 0.750）。饮食在受试者工作特征曲线分析中的结果较差。
POD 1 - 3时的中性粒细胞计数和PLR以及POD 4 - 7时的NLR对择期食管手术中的吻合口漏具有预测价值。
