摘要
目的 :探讨术前外周血中性粒细胞与淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)在胰腺导管腺癌(pancreatic ductal adenocarcinoma,PDAC)患者根治术后预后评估中的价值。方法 :回顾性分析了2006年1月—2013年7月在解放军总医院接受根治性手术的346例PDAC患者的临床及病理资料。采用四分位数(quartile)法,根据患者术前外周血NLR将患者分为4组(NLR<1.83、1.83≤NLR<2.39、2.39≤NLR<3.22和NLR≥3.22);比较各组患者的临床病理特征及无病生存期(disease-free survival,DFS)和总生存期(overall survival,OS)的差异。采用COX回归模型分析影响PDAC患者根治术后预后的独立影响因素。结果 :PDAC患者根治术前外周血NLR的增高与肿瘤位于胰头、肿瘤直径大、组织分化差、病理T分期和N分期高、临床分期晚以及外周血白细胞计数、血小板计数和中性粒细胞计数增高、淋巴细胞计数和血清白蛋白浓度降低均有关(P值均<0.05)。术前外周血NLR大于Q3(NLR≥3.22)患者的1、3和5年的DFS率和OS率均明显低于其他3组患者。4组患者DFS和OS的差异均具有统计学意义(P值均<0.001);单因素及COX多因素分析结果显示,除肿瘤最大直径、肿瘤分化程度、病理T分期和病理N分期外,术前外周血NLR也是影响PDAC患者根治术后DFS和OS的独立预后因素。结论 :术前外周血NLR可作为PDAC患者根治术后的独立预后因素。
Objective：To investigate the prognostic value of preoperative neutrophil-to-lymphocyte ratio（NLR） in patients with pancreatic ductal adenocarcinoma（PDAC） after radical resection.Methods：Clinical and pathological information from 346 patients with PDAC receiving radical resection in Chinese People’s Liberation Army General Hospital between January 2006 and July 2013 were analyzed.Patients were stratified into four groups（NLR 〈 1.83,1.83 〈NLR 〈 2.39,2.39 〈 NLR 〈 3.22,NLR 〉 3.22） according to preoperative NLR by quartile method.The clinical characteristic,disease-free survival（DFS） and overall survival（OS） of 4groups were analyzed.Multivariable COX regression was used to determine the independent prognostic factors.Results：As compared with NLR〈 1.83 group,preoperative NLR in patients with PDAC receiving radical resection was increased.NLR 〉 3.22 was significantly correlated with tumor in head of pancreas,bigger tumor diameter,poor differentiation,higher T stage and N stage,clinical progression,higher white blood cell,platelet and neutrophil counts,lower lymphocyte count,and lower albumin concentration level（all P 〈 0.05）.Patients with NLR 〉 3.22 had lowest1-year,3-year and 5-year DFS rates and OS rate as compared with those in the other three groups.Significant differences in DFS and OS were also found between NLR 〉 3.22 group and NLR 〈 1.83 groups.Univariate analysis and multivariate analyses showed that preoperative NLR was an independent prognostic factor of DFS and OS in patients after curative pancreatic resection for PDAC,along with tumor size,the degree of tumor differentiation,T stage,and lymph node metastasis.Conclusion：Preoperative NLR is an independent prognostic factor in patients undergoing radical resection for pancreatic adenocarcinoma.
出处
《肿瘤》
CAS
CSCD
北大核心
2016年第3期310-318,共9页
Tumor
