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Received:December 12, 2022 Published Online:September 19, 2023
Received:December 12, 2022 Published Online:September 19, 2023
中文摘要: 目的 探讨在胃癌合并脉管癌栓的预测中，术前血液炎症指标的价值。方法 以2020年10月至2022年7月在江苏省肿瘤医院接受手术切除且均经病理学检查证实为胃癌的341例患者为对象进行回顾性研究。按术后病理有无脉管癌栓分为脉管癌栓阳性组（n=163）和脉管癌栓阴性组（n=178）。收集患者术前中性粒细胞与淋巴细胞比值（NLR），血小板与淋巴细胞比值（PLR），淋巴细胞与单核细胞比值（LMR），纤维蛋白原与淋巴细胞比值（FLR）及常用肿瘤标志物水平和临床资料，采用受试者工作特征曲线（ROC）评价NLR、PLR、FLR对脉管癌栓形成的预测能力并寻找最佳截断值，logistic回归行单因素分析胃癌患者脉管癌栓形成的影响因素，同时构建logistic回归胃癌脉管癌栓预测模型。结果 与脉管癌栓阴性患者相比，阳性患者的NLR、PLR、FLR以及糖类抗原（CA）19-9水平显著增高，同时肿瘤浸润程度增加、淋巴结转移率更高（P＜0.05）。ROC曲线分析：NLR、PLR和FLR的最佳截断值分别为1.68、115.29和1.96。胃癌患者发生脉管癌栓的logistic预测模型：Logit（P）=-2.117+0.890×X1+0.286×X2+0.917×X3（X1=PLR,X2=cT,X3=淋巴结转移）；模型拟合度较好（χ=58.405,P＜0.01），预报正确率为67.26%；AUC=0.733（95%CI: 0.680~0.786,P＜0.01）；该模型分析显示，PLR＞115.29（OR=2.436,95%CI: 1.386~4.282,P=0.002）、cT分期（OR=1.331, 95%CI: 1.013~1.749, P=0.030）和发生淋巴结转移（OR=2.503, 95%CI: 1.507~4.156,P＜0.01）是预测胃癌患者发生脉管癌栓的独立危险因素。结论 术前监测PLR水平对评估胃癌患者发生脉管癌栓有一定预测价值，可以作为判断癌栓形成的辅助手段。
Abstract:Objective To investigate the predictive value of preoperative hematological inflammatory markers in gastric cancer (GC) with lymphovascular invasion(LVI). Methods A retrospective study was conducted on 341 GC patients who undergoing surgical resection and confirmed by pathological examination in Jiangsu Cancer Hospital from October 2020 to July 2022. The patients were divided into a positive group (n=163) and a negative group (n=178) based on the presence or absence of vascular cancer thrombi in postoperative pathology. Before operation, the following clinical data were collected, including neutrophil to lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), lymphocyte-monocyte ratio(LMR), fibrinogen-lymphocyte ratio (FLR) and common tumor markers. The receiver operating characteristic (ROC) curve was used to evaluate the predictive ability of NLR, PLR and FLR for LVI to find the optimal cut-off values. Univariate logistic regression was used to analyze the influencing factors of LVI in GC patients, and a logistic regression model for predicting LVI in GC patients was constructed. Results Compared with those in the patients with LVI negative, the levels of NLR, PLR, FLR and carbohydrate antigen (CA)19-9, the tumor infiltration depth and the rate of lymph node metastasis rate significantly increased in LVI positive patients(P＜0.05). ROC curve analysis showed that the best cutoff values of NLR, PLR and FLR were 1.68, 115.29 and 1.96 respectively. The logistic regression model of LVI in GC patients showed that Logit(P)=-2.117+0.890×X1+0.286×X2+0.917×X3(X1=PLR, X2=cT, X3=lymph node metastasis) had a good model fit(χ=58.405, P＜0.01), with the prediction accuracy of 67.26% and an AUC of 0.733 (95%CI: 0.680-0.786, P＜0.01), and this model analysis suggested that PLR(＞115.29, OR=2.436, 95%CI: 1.386-4.282, P=0.002), cT stage (OR=1.331, 95%CI: 1.031-1.749, P=0.030) and lymph node metastasis(OR=2.503, 95%CI: 1.507-4.156, P＜0.001) were the independent risk factors for LVI in patients with GC. Conclusion Preoperative monitoring of PLR level has a certain predictive value in evaluating the occurrence of LVI in GC patients, and can be used as a supplementary indicator to judge the formation of LVI.
keywords: Gastric cancer Inflammatory marker Lymphovascular invasion Fibrinogen Neutrophils Lymphocytes Platelets Monocyte
文章编号： 中图分类号：R735.2 文献标志码：A
基金项目:国家自然科学基金（82002225，81871718）
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