發(fā)布時(shí)間：2018-11-21 12:16

【摘要】：背景與目的:目前已有多項(xiàng)研究證實(shí)食管癌患者術(shù)前全身炎性反應(yīng)相關(guān)指標(biāo),如粒淋比(NLR)、血淋比(PLR)、淋單比(LMR),能夠預(yù)測(cè)術(shù)后食管癌患者預(yù)后。然而,NLR、PLR、LMR與接受放療的食管癌患者的預(yù)后關(guān)系則未見報(bào)道。本研究目的是探討全身炎性反應(yīng)相關(guān)指標(biāo)在食管癌放療患者預(yù)后預(yù)測(cè)中的臨床價(jià)值。資料與方法:回顧性分析2009年至2014年在山東大學(xué)齊魯醫(yī)院接受放射治療的食管癌患者。收集其基線臨床特征、放療前1周內(nèi)血液分析報(bào)告以及CT報(bào)告。粒淋比(NLR)的計(jì)算方式為食管癌患者的周圍血中性粒細(xì)胞與淋巴細(xì)胞計(jì)數(shù)的絕對(duì)值之比。以此類推,血淋比(PLR)是血小板與淋巴細(xì)胞計(jì)數(shù)的絕對(duì)值之比,淋單比(LMR)的計(jì)算公式是食管癌放療患者放療前的周圍血淋巴細(xì)胞及單核細(xì)胞計(jì)數(shù)的絕對(duì)值之比。以NLR=2為界,PLR=150為界,LMR=3.57為界,將資料分為兩組進(jìn)行分析。運(yùn)用卡方檢驗(yàn)分析NLR、PLR、LMR與患者基線臨床特征的關(guān)系。對(duì)于NLR、PLR、LMR與患者無(wú)進(jìn)展生存期(PFS)的分析,我們采用Kaplan-Meier法繪制生存曲線,并利用Log-rank檢驗(yàn)比較差異。采用Cox比例風(fēng)險(xiǎn)模型對(duì)相關(guān)變量進(jìn)行單因素分析。本研究中數(shù)據(jù)均采用SPSS23軟件進(jìn)行統(tǒng)計(jì)學(xué)分析,p0.05結(jié)果有統(tǒng)計(jì)學(xué)差異。結(jié)果:本研究共納入86例患者,其中男性患者75例,女性患者11例。中位年齡63歲。中位隨訪時(shí)間11個(gè)月(1-68月)。中位無(wú)進(jìn)展生存11個(gè)月�？ǚ綑z驗(yàn)顯示NLR兩組患者間基線臨床特征均未見統(tǒng)計(jì)學(xué)差異;PLR兩組患者間年齡上存在明顯差異(p=0.005);LMR兩組患者性別因素存在明顯差異(p=0.036)。高NLR組中位PFS為10月,低NLR組中位PFS為12月(log-rank p=0.048)。高PLR組中位PFS為10月,低PLR組中位PFS為14.5月(log-rank p0.05)。高LMR 組中位 PFS 為 10 月,低 LMR 組中位PFS 為 11 月(log-rank p0.05)。Cox比例風(fēng)險(xiǎn)風(fēng)險(xiǎn)模型結(jié)果顯示粒淋比組、血淋比組、淋單比組風(fēng)險(xiǎn)比(HR)分別為 0.56,0.65 和 1.15。結(jié)論:血淋比和淋單比不能預(yù)測(cè)接受放療的食管癌患者PFS。放療前粒淋比較高的食管癌患者比粒淋比較低的患者PFS短。放療前粒淋比一定程度上可預(yù)測(cè)接受放療的食管癌患者的預(yù)后,但這種預(yù)測(cè)效力并不強(qiáng)。
[Abstract]:Background & objective: several studies have confirmed that preoperative systemic inflammatory response in patients with esophageal cancer, such as granulocyte lymphocyte ratio (NLR), blood lymphocyte ratio (PLR),) to single lymphocyte ratio (LMR), can predict the prognosis of postoperative esophageal cancer patients. However, the relationship between NLR,PLR,LMR and prognosis in patients with esophageal cancer undergoing radiotherapy has not been reported. The purpose of this study was to evaluate the prognostic value of systemic inflammatory response markers in patients with esophageal cancer after radiotherapy. Materials and methods: esophageal cancer patients receiving radiotherapy from 2009 to 2014 in Qilu Hospital Shandong University were retrospectively analyzed. The baseline clinical features, blood analysis report and CT report within 1 week before radiotherapy were collected. The granulocyte ratio (NLR) was calculated as the absolute ratio of peripheral blood neutrophils to lymphocyte counts in patients with esophageal cancer. By analogy, (PLR) is the absolute ratio of platelet to lymphocyte count, and the (LMR) formula is the absolute ratio of peripheral blood lymphocytes and monocytes before radiotherapy in patients with esophageal cancer. Taking NLR=2 as the boundary, PLR=150 as the boundary, and LMR=3.57 as the boundary, the data were divided into two groups for analysis. Chi-square test was used to analyze the relationship between NLR,PLR,LMR and baseline clinical features. For the analysis of NLR,PLR,LMR and (PFS), Kaplan-Meier method was used to draw the survival curve, and Log-rank test was used to compare the difference. The Cox proportional risk model is used to analyze the related variables. In this study, the data were analyzed by SPSS23 software, p0.05 results were statistically different. Results: a total of 86 patients were included in this study, including 75 male and 11 female. The median age was 63 years. The median follow-up time was 11 months (1-68 months). Median no progress survival for 11 months. Chi square test showed that there was no statistical difference in baseline clinical characteristics between the two groups of NLR, and there was a significant difference in age between the two groups of PLR (p0. 005); LMR and 2 groups) (p0. 036). The median PFS of high NLR group was 10 months and that of low NLR group was 12 months (log-rank p0. 048). The median PFS of high PLR group was 10 months, while that of low PLR group was 14. 5 months (log-rank p 0. 05). The median PFS was 10 months in the high LMR group, and the median PFS was 11 months in the low LMR group (log-rank p0.05). Cox proportional risk model). The results showed that the (HR) of the granulocyte ratio group, the blood lymphocyte ratio group and the single lymphocyte ratio group were 0.560.65 and 1.15, respectively. Conclusion: hemolymph ratio and lymphocytic ratio can not predict PFS. in patients with esophageal cancer undergoing radiotherapy. PFS was shorter in esophageal cancer patients with higher granulocyte levels before radiotherapy than in patients with lower granulocyte lymphocytic levels. The granulocyte ratio can predict the prognosis of esophageal cancer patients who received radiotherapy to some extent, but this predictive effect is not strong.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735.1

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