外周血血小板与淋巴细胞比值和微量元素评估胃癌术后复发转移的价值

目的:探讨外周血血小板与淋巴细胞比值(platelet-to-lymphocyte ratio，PLR)和微量元素评估胃癌术后复发转移的价值。方法:以胃癌术后3年内是否发生复发转移将所有纳入研究的患者分为复发转移组与未复发转移组，并且作为因变量，各临床病理指标作为自变量，通过1∶1倾向性评分匹配法进行匹配，检验匹配后两组临床病理指标的均衡性，采用单因素和多因素Cox回归模型分析匹配后PLR和微量元素对胃癌患者术后复发转移的影响，获得独立预测因子，绘制独立预测因子预测胃癌患者术后3年内复发转移的ROC曲线，获得独立预测因子的最佳诊断截点，并以最佳诊断截点将匹配后患者分为两组，Kaplan-Meier生存分析比较两组胃癌患者术后无病生存率。结果:两组共48对匹配成功，匹配后两组各临床病理特征比较均无统计学差异。Cox回归分析结果显示，匹配后Cu/Zn和PLR为影响胃癌患者术后复发转移的独立预测因素。ROC曲线显示，选取PLR=190作为最佳诊断截点来预测胃癌患者术后3年内复发转移的灵敏度和特异度分别为81.6％和76.5％，AUC为0.778；选取Cu/Zn=1.72作为最佳诊断截点来预测胃癌患者术后3年内复发转移的灵敏度和特异度分别为78.5％和71.2％，AUC为0.712。Kaplan-Meier生存分析显示，匹配后PLR<190组胃癌患者术后1年、2年、3年无病生存率显著高于PLR≥190组（80.6%、63.6%、51.8% vs 58.5%、41.2%、35.9%，P＜0.05）；Cu/Zn<1.72组胃癌患者术后1年、2年、3年无病生存率显著高于Cu/Zn≥1.72组（84.1%、57.5%、50.9% vs 38.2%、31.2%、31.2%，P＜0.05）。结论:术前Cu/Zn和PLR结合各自最佳诊断截点评估胃癌患者术后无病生存情况具有较高的临床应用价值。

The value of platelet-to-lymphocyte ratio and trace elements in evaluating postoperative recurrence and metastasis of gastric cancer

Objective:To investigate the value of platelet-to-lymphocyte ratio (PLR) and trace elements in evaluating postoperative recurrence and metastasis of gastric cancer.Methods:All patients were divided into recurrence and metastasis group and non-recurrence and metastasis group according to 3-year recurrence and metastasis of gastric cancer after operation,and as dependent variables,each clinicopathological index as independent variable.1∶1 propensity score matching method was used to match.The balance of clinicopathological indicators between the two groups after matching was tested.Univariate and multivariate Cox regression model were used to analyze the effect of PLR and trace elements on disease-free survival time of postoperative gastric cancer patients.The independent predictors were obtained.ROC curve of independent predictors was drawn to predict 3-year recurrence and metastasis of gastric cancer patients after operation.The best diagnostic cut-off point of independent predictors was obtained.The matched patients were divided into two groups according to the best diagnostic cut-off point.Kaplan-Meier survival analysis was used to compare the disease-free survival rate of postoperative gastric cancer patients between the two groups.Results:A total of 48 pairs were successfully matched in the two groups.There was no significant difference in the clinicopathological features between the two groups after matching.Cox regression analysis showed that Cu/Zn and PLR were independent predictors of postoperative recurrence and metastasis of gastric cancer patients.ROC curve showed that when PLR=190 was the best diagnostic cut-off point to predict 3-year recurrence and metastasis of gastric cancer patients after operation.The sensitivity and specificity were 81.6% and 76.5%,respectively,and the AUC was 0.778,and the sensitivity,specificity and AUC of Cu/Zn=1.72 were 78.5%,71.2% and 0.712,respectively.Kaplan-Meier survival analysis showed 1-year,2-year and 3-year disease-free survival rate of gastric cancer patients in PLR<190 group were significantly higher than those in PLR≥190 group (80.6%,63.6%,51.8% vs 58.5%,41.2%,35.9%,P＜0.05).The 1-year,2-year and 3-year disease-free survival rate in Cu/Zn<1.72 group were significantly higher than those in Cu/Zn≥1.72 group (84.1%,57.5%,50.9% vs 38.2%，31.2%,31.2%,P＜0.05).Conclusion:Preoperative Cu/Zn and PLR combining with their respectively best diagnostic cut-off point to evaluate postoperative disease-free survival of gastric cancer patients has high clinical application value.