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Received:October 29, 2020 Published Online:June 20, 2021
Received:October 29, 2020 Published Online:June 20, 2021
中文摘要: 目的 探讨放疗联合热疗前中性粒细胞与淋巴细胞比值(NLR)、预后营养指数(PNI)与无法手术的进展期胃癌放疗联合热疗患者总生存时间(OS)的相关性。方法 选取2014年至2019年12月河北工程大学附属医院收治的39例无法手术的进展期胃癌放疗联合热疗患者进行回顾性研究,在治疗前采集外周血及临床特征资料,计算NLR与PNI,采用受试者工作曲线(ROC),确定治疗前NLR及PNI预测患者预后的最佳截断值,分析治疗前NLR、PNI水平与临床特征变量的关系。绘制不同NLR、PNI的生存曲线,使用Cox回归模型进行OS的单因素与多因素分析,分析影响无法手术的进展期胃癌放疗联合热疗的OS的因素。结果 NLR预测患者预后的最佳截断值为2.6,PNI的最佳截断值为49.33,并根据NLR的最佳截断值分组为高NLR组(NLR≥2.6),低NLR组(NLR<2.6);根据PNI的最佳截断值分组为高PNI组(PNI≥49.33),低PNI组(PNI<49.33)。放疗联合热疗前高NLR组与低NLR组患者性别、病变部位、病理类型、TNM分期、年龄、序贯化疗方案上差异无统计学意义(P>0.05)，是否同步化疗差异有统计学意义（P<0.05）。放疗联合热疗前高PNI组与低PNI组患者在性别、病变部位、病理类型、TNM分期、年龄、序贯化疗方案、是否同步化疗上差异无统计学意义(P>0.05)。单因素分析发现放疗联合热疗前PNI、KPS评分、NLR、否同步化疗与无法手术的进展期胃癌放疗联合热疗的OS有关(P<0.05，P<0.01),多因素分析发现放疗联合热疗前KPS评分、NLR是影响无法手术的进展期胃癌放疗联合热疗患者OS的独立预后因素(P<0.05)。结论 放疗联合热疗前KPS评分、NLR是无法手术的进展期胃癌放疗联合热疗患者OS的独立预后因素。
Abstract:Objective To explore the associations of neutrophil to lymphocyte ratio(NLR) and prognostic nutritional index (PNI)before radiotherapy and hyperthermia with total overall survival (OS) in the patients with inoperable advanced gastric cancer. Methods Thirty-nine patients with unresectable and advanced gastric cancer treated with radiation therapy and hyperthermia from December 2014 to December 2019 were retrospectively studied.Receiver operating characteristic (ROC) curve was used to determine the optimum cut-off value of NLR and PNI for predicting the prognosis of patients before radiation therapy and hyperthermia and to analyze the relationship between the levels of NLR and PNI and the clinical characteristic variables.The survival curves of NLR and PNI were drawn.The COX regression model was used to do the univariate analysis and multivariate analysis,and to analyze the factors influencing OS of radiotherapy combined with hyperthermia for inoperable advanced gastric cancer. Results According to the optimal cut-off values of NLR (2.6) and PNI(49.33)for predicting the prognosis of patients,there were high NLR group (NLR≥2.6),low NLR group (NLR<2.6),high PNI group (PNI≥49.33) and low PNI group (PNI<49.33).There were no significant differences in gender,lesion site,pathological type,TNM classification,age,whether concurrent chemotherapy or not and sequential chemotherapy regimen between high NLR group and low NLR group before treatment(all P>0.05).Between high PNI group and low PNI group,there was no significant difference in gender,lesion site,pathological type,TNM classification,whether concurrent chemotherapy or not,sequential chemotherapy regimen and age before treatment(all P>0.05).Univariate analysis showed that Karnofsky Performance Score(KPS),whether concurrent chemotherapy or not,PNI and NLR levels were significantly correlated with OS(P<0.05).Multivariate analysis showed that KPS score and NLR were the independent prognostic factors for overall survival (P<0.05). Conclusion KPS score and NLR are the independent prognostic factors for patients with inoperable advanced gastric cancer treated with radiation therapy and hyperthermia.
keywords: Advanced gastric cancer Prognosis Neutrophil to lymphocyte ratio Prognostic nutritional index Radiation therapy Hyperthermia
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基金项目:吴阶平医学基金会临床科研专项资助基金(320.6750.17057)
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