中性粒细胞—淋巴细胞比预测早期胃癌淋巴结转移的临床价值

目的分析中性粒细胞—淋巴细胞比(NLR)预测早期胃癌(EGC)淋巴结转移的临床价值,以期为EGC治疗方案的制订提供参考。方法回顾性分析在我院行胃癌根治术并经术后病理确诊为EGC的134例患者的临床资料,根据淋巴结是否转移分为阳性组和阴性组。收集EGC患者术前1周血液学指标并计算血小板—淋巴细胞比(PLR)和NLR;收集患者基本信息及术后病理信息,行单因素和多因素Logistic回归分析;通过受试者工作特征(ROC)曲线分析NLR预测EGC伴淋巴结转移阳性的诊断价值;分析术前NLR与患者一般资料及临床病理之间的相关性;Pearson相关性检验分析NLR与肿瘤大小的相关性;Kaplan-Meier(K-M)曲线及Log-rankχ2检验比较高NLR组和低NLR组患者术后生存状况。结果单因素分析结果显示,浸润深度、分化程度、肿瘤大小、PLR、NLR与淋巴结转移相关(P<0.05)。多因素Logistic回归分析结果显示,肿瘤大小≥2cm、浸润深度为黏膜下层、分化程度为低分化、NLR≥1.965是淋巴结转移的独立危险因素(P<0.05)。根据ROC曲线,NLR截断值为2.295,术前NLR预测淋巴结转移的灵敏性和特异性分别为82.6%和77.5%。根据截断值将所有患者分为低NLR组(NLR<2.295)90例和高NLR组(NLR≥2.295)44例,2组患者一般资料及临床病理相关因素分析结果显示,术前NLR与年龄、肿瘤大小、肿瘤大体类型显著相关(P<0.05)。术前NLR与肿瘤大小呈正相关(r=0.645,P<0.001)。术前高NLR组患者术后5年生存率明显低于低NLR组患者(P<0.05)。结论术前NLR对EGC患者发生淋巴结转移具有较高的预测价值,且对EGC患者预后的评估具有一定的临床参考价值。

Clinical value of neutrophil-lymphocyte ratio in predicting lymph node metastasis of early gastric cancer

Objective To analyze the clinical value of neutrophil-lymphocyte ratio( NLR) in predicting lymph node metastasis of early gastric cancer( EGC),so as to provide reference for the formulation of treatment plan for EGC. Methods The clinical data of 134 patients with EGC diagnosed by pathology after radical gastrectomy in our hospital were retrospectively analyzed,and they were divided into positive group and negative group according to whether lymph node metastasis was present. Hematological indexes of EGC patients were collected1 week before surgery,and platelet-to-lymphocyte ratio( PLR) and NLR were calculated. The basic information and postoperative pathological information of patients were collected to conduct univariate analysis and multivariate Logistic regression analysis. The diagnostic value of NLR in predicting positive EGC with lymph node metastasis was analyzed by receiver operating characteristic( ROC) curve. The correlation between preoperative NLR and patients’ general information and clinicopathology was analyzed. Pearson correlation test was used to analyze the correlation between NLR and tumor size. Kaplan-Meier( K-M) curve and Log-rank test χ~2 were used to compare the postoperative survival of patients in the high and low NLR groups. Results Univariate analysis showed that depth of invasion,degree of differentiation,tumor size,PLR,NLR were correlated with lymph node metastasis( P < 0. 05). Multivariate Logistic regression analysis showed that tumor size≥2 cm,depth of invasion( infiltrated into the submucosa),degree of differentiation( poor differentiation) and NLR≥1. 965 were the independent risk factors for lymph node metastasis( P < 0. 05). According to the ROC curve,the cut-off value of NLR was 2. 295,and the sensitivity and specificity of preoperative NLR in predicting lymph node metastasis were 82. 6% and 77. 5%,respectively. All patients were divided into low NLR group( NLR < 2. 295,with 90 cases) and the high NLR group( NLR≥2. 295,with 44 cases). The analysis results of general data and clinicopathological factors of patients in the two groups showed that the preoperative NLR was significantly correlated with the age,tumor size and general tumor type( P < 0. 05). Preoperative NLR was positively correlated with tumor size( r = 0. 645,P < 0. 001). The 5-year survival rate of patients in the high preoperative NLR group was significantly lower than that of patients in the low NLR group( P < 0. 05). Conclusion Preoperative NLR has a certain predictive value for the occurrence of lymph node metastasis in EGC patients,which can provide clinical reference for the prognosis evaluation of EGC patients.