Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi.
J Assoc Physicians India. 2022 Apr;70(4):11-12.
Gallbladder carcinoma (GBC) is likely to be diagnosed at progressive stages and shows a very poor prognosis. Combination of gemcitabine and cisplatin (GEMCIS) has been widely used as first line palliative chemotherapy. Prognostic significance of inflammatory markers Neutrophil to lymphocyte ratio (NLR) and Platelet to lymphocyte ratio (PLR) in advanced gallbladder carcinoma (GBC) is not well established.
30 patients who were diagnosed as advanced/ metastatic gallbladder carcinoma with age more than 18 years were included. All patients who were fit to receive chemotherapy was started on gemcitabine 1000mg/m2 and cisplatin 25mg/m2 (GEMCIS) administered intravenously on days 1 and 8 every 3 weeks. The treatment was repeated for a total of 6 cycles or until the occurrence of unacceptable toxicity, loss to follow up, confirmation of disease progression or death. All the patients underwent Contrast enhanced CT scan along with markers NLR, PLR, carcinoembryonic antigen (CEA), carbohydrate antigen 19.9 (CA19.9) at the baseline and at the end of 3 and 6 cycles of chemotherapy and the tumour response was assessed based on Response Evaluation Criteria in Solid Tumours RECIST 1.1 criteria. Progression free survival was calculated from the date of documentation of best response. The response was correlated with markers CEA, CA19.9, NLR and PLR.
At a cut-off of NLR (>3 ng/ml) and PLR (>190) predicts progression with a sensitivity of 91% and 100% respectively and both with a specificity of 100%. Out of 30 participants 11 (36.7%) had disease progression (p<0.001). Disease progression noted in 8 participants (26.7%) after 3 cycles (P<0.001) and in 3 participants (13.6%) after 6 cycles of chemotherapy (p <0.001). Disease control rate was 63.33%: 01(3.3%) patient with complete response, 07(23.3%) patients with partial response, 11(36.7%) patients with stable disease. Mean progression free survival in participants associated with progressive disease was 11.45±5.54 weeks (p <0.001). Neutrophil to lymphocyte ratio (NLR) >3 (95%CI 7.6-13.6; log rank test P<0.01) and Platelet to lymphocyte ratio (PLR) >190 (95%CI 7.67-8.83; log rank test p<0.001) were significantly associated with worse progression free survival.
Increased levels of NLR (>3) and PLR (>190) have prognostic value to predict progression free survival (PFS) in advanced gallbladder carcinoma patients on palliative chemotherapy. NLR and PLR can be used as prognostic markers in advanced gallbladder carcinoma.
胆囊癌（GBC）可能在进展期被诊断，预后极差。吉西他滨联合顺铂（GEMCIS）已广泛用于一线姑息化疗。炎性标志物中性粒细胞与淋巴细胞比值（NLR）和血小板与淋巴细胞比值（PLR）在晚期胆囊癌（GBC）中的预后意义尚未明确。
纳入 30 例年龄大于 18 岁的晚期/转移性胆囊癌患者。所有符合化疗条件的患者均接受吉西他滨 1000mg/m2 和顺铂 25mg/m2（GEMCIS）静脉滴注，第 1 天和第 8 天，每 3 周 1 次。共重复 6 个周期，或直至出现不可接受的毒性、失访、疾病进展或死亡。所有患者在基线和化疗 3 个周期和 6 个周期结束时均行增强 CT 扫描，并检测 NLR、PLR、癌胚抗原（CEA）、糖链抗原 19.9（CA19.9），根据实体瘤反应评价标准（RECIST 1.1）评估肿瘤反应。无进展生存期从最佳反应记录日期开始计算。将反应与标志物 CEA、CA19.9、NLR 和 PLR 进行相关性分析。
NLR（>3ng/ml）和 PLR（>190）的截断值可预测疾病进展，其敏感性分别为 91%和 100%，特异性均为 100%。30 名参与者中有 11 名（36.7%）出现疾病进展（p<0.001）。8 名患者（26.7%）在 3 个周期后（p<0.001）和 3 名患者（13.6%）在 6 个周期化疗后（p <0.001）出现疾病进展。疾病控制率为 63.33%：01（3.3%）例患者完全缓解，07（23.3%）例患者部分缓解，11（36.7%）例患者疾病稳定。与进展性疾病相关的参与者的中位无进展生存期为 11.45±5.54 周（p <0.001）。NLR（>3）（95%CI 7.6-13.6；对数秩检验 P<0.01）和 PLR（>190）（95%CI 7.67-8.83；对数秩检验 p <0.001）与无进展生存期较差显著相关。
在接受姑息化疗的晚期胆囊癌患者中，NLR（>3）和 PLR（>190）水平升高具有预测无进展生存期（PFS）的预后价值。NLR 和 PLR 可作为晚期胆囊癌的预后标志物。
