术前免疫炎症指数与胃癌患者预后关系的研究

  目的  探讨术前免疫炎症指数（systemic immune-inflammation index,SII）与胃癌患者预后的关系。  方法  回顾性分析2010年6月至2015年6月青海大学附属医院收治的接受手术治疗的胃癌患者临床资料,计算其SII数值。相关性分析采用Spearman相关系数。应用受试者工作特征曲线（receiver operating characteristic curve,ROC）确定SII的最佳临界值,χ2检验评价SII与各项临床病理特征之间的关系。Kaplan-Meier法绘制生存曲线,并计算总生存时间（overall survival,OS）,显著性分析采用Log-rank检验。应用Cox比例风险模型进行预后因素的单因素和多因素分析。  结果  共纳入771例患者,其中男性606例、女性165例,年龄25～81（56.91±9.546）岁。Spearmen相关性分析结果显示,SII与胃癌患者术后生存率呈正相关（r=0.399,P<0.001）。ROC曲线确定SII的最佳临界值为489.52,将771例胃癌患者分为低SII（L-SII）组（SII≤489.52）和高SII（H-SII）组（SII>489.52）。Kaplan-Meier分析显示L-SII组胃癌患者生存率明显优于H-SII组,两组总体生存率差异具有统计学意义（P<0.05）。Ⅰ、Ⅱ、Ⅲ期中L-SII组的5年生存率明显高于H-SII组（分别为81.8% vs. 24.8%、56.5% vs. 21.2%、62.5% vs. 24.6%）,差异具有统计学意义（P<0.05）。单因素分析显示H-SII是胃癌患者预后的危险因素（HR=3.919,95%CI:3.087～4.977,P<0.001）,多因素分析提示术前外周血SII是胃癌患者预后的独立危险因素（HR=2.707,95%CI:2.074～3.533,P<0.001）。再次通过ROC曲线比较SII与其他指标预测胃癌患者预后的能力,显示SII具有更准确的预测能力。将SII联合Alb、CEA、CA125、WBC较单独预测具有更优的预测效能（AUC=0.786）。  结论  SII是胃癌患者预后的独立危险因素。术前外周血SII的升高提示着更差的预后。 

Relationship between preoperative systemic immune-inflammation index and prognosis of gastric carcinoma

Objective: To investigate the relationship between preoperative systemic immune-inflammation index (SII) and prognosis of patients with gastric carcinoma. Methods: Patients with gastric carcinoma who underwent gastrointestinal surgery at Affiliated Hospital of Qinghai University from June 2010 to June 2015 were retrospectively examined, and their SII values were calculated; correlation was determined using Spearman’s correlation coefficient. Receiver operating characteristic (ROC) curve analysis was used to determine the best threshold value of SII as well as the relationship between SII and various clinical and pathological features. The Kaplan–Meier method was used to construct survival curves whose significance was tested using the Log-rank test, and the overall survival (OS) of the two groups of patients was analyzed. A Cox proportional hazard model was used to analyze single factors and multivariate analysis of prognostic factors and to analyze the relationship between SII and prognosis of patients with gastric carcinoma. Result: Overall, 771 patients (606 men and 165 women) were included, aged 25～81 (56.91 ± 9.546) years. According to Spearman’s correlation coefficient analysis, SII positively correlated with gastric carcinoma (r=0.399, P<0.001). The optimal intercept value of SII determined using the ROC curve was 489.52. The 771 patients with gastric carcinoma were assigned into low SII (L-SII) (SII≤489.52) and high SII (H-SII) (SII>489.52) groups. Kaplan–Meier survival curve analysis showed that the survival rate of the L-SII group was evidently high (P<0.05). The 5-year survival rates of the L-SII group in stages Ⅰ, Ⅱ, and Ⅲ were significantly higher than those of the H-SII group (81.8% vs. 24.8%, 56.5% vs. 21.2%, and 62.5% vs. 24.6%, respectively; P<0.05). Univariate analysis showed that H-SII was a risk factor for poor overall survival of patients with gastric carcinoma (HR=3.919, 95%CI: 3.08 - 4.977, P<0.001), while multivariate analysis confirmed that the level of SII is an independent factor in patients with gastric carcinoma (HR=2.707, 95%CI: 2.074 - 3.533, P<0.001). SII was found to have the most accurate predictive ability after comparing its ability with other indicators to predict the prognosis of gastric carcinoma patients using ROC curve analysis. Using SII in combination with Alb, CEA, CA125, and WBC has better predictive capability than using either alone (area under the curve=0.786). Conclusions: A high preoperative SII is an independent risk factor for worse prognosis of patients with gastric carcinoma.