血液炎症相关指标在晚期胰腺癌中的预后价值

doi:10.3969/j.issn.1006-7795.2022.02.023

摘要/Abstract

摘要： 目的评估血液炎症相关指标中性粒细胞-淋巴细胞比值(neutrophil-lymphocyte ratio, NLR)、血小板-淋巴细胞比值(platelet-lymphocyte ratio, PLR)、淋巴细胞-单核细胞比值(lymphocyte-monocyte ratio, LMR)、白蛋白(albumin, ALB)及联合炎症指标在晚期胰腺癌中的预后价值。方法回顾性收集2012年7月至2020年10月北京大学肿瘤医院VIP-Ⅱ病区收治的晚期胰腺癌患者诊断时的基线资料。根据受试者工作特征(receiver operating characteristic, ROC)曲线确定炎症相关指标临界值,根据曲线下面积(area under curve, AUC)估计预后因素的准确性。通过单因素和多因素分析评估预后价值。结果 50例晚期胰腺癌患者中位生存时间7.2个月(95%CI:3.568~10.699)。炎症相关指标的临界值分别为:NLR=4.5(AUC=0.840,95% CI:0.732~0.948,P<0.001),PLR=138(AUC=0.671, 95% CI:0.517~0.826,P=0.038),LMR=4.0(AUC=0.873,95% CI:0.770~0.975,P<0.001),ALB=41.5(AUC=0.726, 95% CI:0.582~0.870, P=0.006)。单因素及多因素分析显示:NLR≥4.5(HR=11.936, 95%CI:4.571~31.169, P<0.001)、PLR≥138(HR=2.246, 95%CI:1.045~4.828, P=0.038)、ALB<41.5 g/L(HR=3.214, 95%CI:1.463~7.060, P=0.004)为独立危险因素;LMR≥4(HR=0.336, 95%CI:0.165~0.687, P=0.003)为独立保护因素。联合炎症指标NLR_ALB、PLR_ALB、LMR_ALB为独立预后指标,评分越高,预后越差。结论 NLR、LMR、PLR、ALB可以作为晚期胰腺癌的预后指标,联合血液炎症相关指标有助于简便、迅速地评估预后,有一定的临床应用前景。

关键词: 胰腺肿瘤, 炎症相关指标, 预后

Abstract: Objective To evaluate significance of the inflammation-based prognostic markers, including neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), lymphocyte-monocyte ratio (LMR), albumin (ALB) and combined inflammation-based markers in metastatic pancreatic cancer. Methods The clinical data of 50 patients with metastatic pancreatic cancer admitted to VIP-Ⅱ Department of Peking University Cancer Hospital from July 2012 to October 2020 were collected retrospectively. Receiver operating characteristic (ROC) curve analysis were performed to determine the cut-off values of NLR, LMR, PLR and prognostic nutritional index (PNI). The accuracy of the prognostic indicators were evaluated by area under curve(AUC). The prognostic significance of the clinical characteristics and inflammation-based markers were evaluated by univariate and multivariate analysis. Results In 50 patients with metastatic pancreatic cancer, the median overall survival was 7.2 months (95%CI:3.568-10.699). The optimal cut-off of inflammation-based markers were: NLR=4.5 (AUC=0.840, 95%CI:0.732-0.948, P<0.001), PLR=138 (AUC=0.671, 95%CI:0.517-0.826, P=0.038), LMR=4.0 (AUC=0.873, 95% CI:0.770-0.975, P<0.001), ALB=41.5(AUC=0.726, 95% CI:0.582-0.870, P=0.006), respectively. Univariate and multivariate analysis showed that NLR≥4.5 (HR=11.936, 95%CI:4.571-31.169, P<0.001), PLR≥138 (HR=2.246, 95%CI:1.045-4.828, P=0.038), ALB<41.5 g/L (HR=3.214, 95%CI:1.463-7.060, P=0.004) were independent risk factors; LMR≥4 (HR=0.336, 95%CI:0.165-0.687, P=0.003) was an independent protective factor. NLR_ALB, PLR_ALB and LMR_ALB were independent prognostic indicators, and the higher the score, the worse the prognosis. Conclusion Peripheral blood inflammation-based marker NLR, LMR, PLR and ALB can be used as prognostic indicators for metastatic pancreatic cancer, the combined inflammation-based markers will promote simple and rapid prognosis assessments and has a certain clinical application prospect.

Key words: pancreatic neoplasms, inflammation-based markers, prognosis

中图分类号:

R735.9

孙婧, 史幼梧, 贾军, 杨颖, 孙志伟, 杜丰, 余靖, 肖艳洁, 张晓东. 血液炎症相关指标在晚期胰腺癌中的预后价值[J]. 首都医科大学学报, 2022, 43(2): 299-304.

Sun Jing, Shi Youwu, Jia Jun, Yang Ying, Sun Zhiwei, Du Feng, Yu Jing, Xiao Yanjie, Zhang Xiaodong. Prognostic value of peripheral blood inflammation-based markers in metastatic pancreatic cancer[J]. Journal of Capital Medical University, 2022, 43(2): 299-304.

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