放疗前中性粒细胞/淋巴细胞血小板/淋巴细胞预后营养指数及CA19-9与胰腺腺癌放疗后预后关系的分析

  目的  探讨胰腺癌患者放疗前外周血中性粒细胞与淋巴细胞的比值（neutrophil to lymphocyte ratio，NLR）、血小板与淋巴细胞的比值（platelet to lymphocyte ratio，PLR）、预后营养指数（prognostic nutritional index，PNI）及糖类抗原19-9（carbohydrate antigen 19-9，CA19-9）与总生存时间（overall survival，OS）关系。  方法  回顾性分析2008年3月~2013年3月空军总医院61例经病理确诊为胰腺腺癌的患者临床资料，并通过电子病历查询患者治疗前检验结果，通过电子病历记录或电话随访获得患者OS。采用Ka? plan-Meier方法构建生存曲线，组间差异比较用Log-rank检验，单因素及多因素的分析运用Cox比例风险模型进行。  结果  利用log-rank检验及单因素回归分析，提示NLR、PLR、CA19-9增高、PNI降低、TNM分期晚，患者生存期短，差异具有统计学意义。多因素回归分析显示，NLR（P=0.029，OR 2.344，95%CI:1.090~5.041）；PNI（P=0.026，OR 0.477，95%CI:0.248~0.917）是胰腺癌患者OS的独立影响因素。  结论  NLR、PLR、PNI等是评价胰腺癌患者预后较为简单、有效的可靠指标之一. 

Pre-radiation neutrophil to lymphocyte ratio,platelet to lymphocyte ratio,prognostic nutritional index,and CA19-9 as prognostic factors in pancreatic cancer patients treat-ed with radiotherapy

Objective:To investigate the prognostic value of neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and prognostic nutritional index (PNI) before radiation in pancreatic cancer patients underwent radiation therapy. Methods:Clinical data of 61 patients with pathologically confirmed pancreatic cancer were retrospectirely analyzed. Query index values for each patient were clinically tested through electronic medical records. Overall survival (OS) data were collected through electronic medical records or telephone follow-up. Survival curves were compared using Kaplan-Meier methodology and log-rank test. Cox regression methodolo-gy was used for univariate analysis. Results:Using log-rank test and univariate regression analysis, we found that patients with lower NLR, PLR, CA19-9, increased PNI, and lower TNM-staging lived longer than those with increased NLR, PLR, CA19-9, lower PNI, and high-er TNM-staging, and that the difference was statistically significant. Through multivariate analysis, we found that NLR (P=0.029, OR 2.344, 95%CI:1.090-5.041) and PNI (P=0.026, OR 0.477, 95%CI:0.248-0.917) were independent predictors of OS in patients with pan-creatic cancer. Conclusion:NLR, PLR, and PNI are simple, effective, and reliable indicators for evaluating the prognosis of pancreatic cancer.