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目的探讨术前血小板/淋巴细胞比值(PLR)、衍生中性粒细胞/淋巴细胞比值(d-NLR)对胃肠间质瘤(GIST)患者预后的影响及其临床意义。方法选取四川大学华西医院胃肠外科2005年6月至2015年2月经手术治疗的GIST患者作为研究对象,并收集患者术前一周内的血液常规检查结果及临床病理资料。根据受试者工作特征曲线(ROC曲线)确定的术前PLR、d-NLR的最佳截断值将患者分为高值组(PLR>153.075、d-NLR>1.245)和低值组(PLR≤153.075、d-NLR≤1.245)。观察比较高、低PLR、d-NLR组的一般病理资料,采用KaplanMeier法绘制生存曲线,采用单因素及多因素Cox风险回归探讨影响未行伊马替尼辅助治疗的GIST患者预后的因素。结果无论GIST患者术后是否接受伊马替尼辅助治疗,与低PLR组、低d-NLR组相比,高PLR组、高dNLR组患者术后无复发生存时间(RFS)更短(P均<0.05)。单因素分析中,肿瘤直径、部位、核分裂象数,术前PLR及d-NLR与患者术后RFS相关。Cox多因素分析发现,肿瘤直径≥5cm〔风险比(HR):4.295,95%可信区间(CI):1.772~10.413;P=0.001〕、非胃部位(HR:2.247,95%CI:1.200~4.209;P=0.011)、核分裂象数>5/50HPF(HR:4.678,95%CI:2.364~9.257;P<0.001)及术前高d-NLR(HR:2.549,95%CI:1.159~5.606;P=0.020)是GIST患者术后RFS的独立危险因素。在NIH高危患者中,高PLR或高d-NLR组(B组)患者较低PLR和低d-NLR组(A组)患者RFS更短(P=0.006)。结论术前d-NLR的高低是GIST预后的独立危险因素,术前PLR、d-NLR可作为评估GIST术后RFS的重要指标之一,有望在临床上预测GIST复发风险。
Objective To investigate the effect of preoperative platelet / lymphocyte ratio (PLR) and derived neutrophil / lymphocyte ratio (d-NLR) on the prognosis of patients with gastrointestinal stromal tumors (GIST) and its clinical significance. Methods Gastrointestinal surgery in West China Hospital of Sichuan University from June 2005 to February 2015 was performed in patients with GIST. The routine blood tests and clinicopathological data were collected within one week before surgery. According to the receiver operating characteristic curve (ROC curve), the best preoperative PLR and d-NLR cutoff were divided into high value group (PLR> 153.075, d-NLR> 1.245) and low value group 153.075, d-NLR ≦ 1.245). The common pathological data of high and low PLR and d-NLR group were observed. The survival curve was drawn by KaplanMeier method. The prognosis of GIST patients without adjuvant imatinib treatment was investigated by univariate and multivariate Cox risk regression. Results Regardless of the adjuvant chemotherapy with imatinib in patients with GIST, the patients with high PLR and high dNLR had shorter postoperative recurrence-free survival (RFS) than those with low PLR and low d-NLR <0.05). In univariate analysis, tumor diameter, location, mitotic figures, preoperative PLR and d-NLR correlated with postoperative RFS. Cox multivariate analysis showed that tumor diameter ≥5 cm (hazard ratio (HR): 4.295, 95% confidence interval (CI): 1.772 to 10.413; (HR: 4.678, 95% CI: 2.364 ~ 9.257; P <0.001) and preoperative high d-NLR (HR: 2.549, 95% CI: 1.159 ~ 5.606; P = 0.020) were independent risk factors for postoperative RFS in GIST patients. In NIH-at-risk patients, patients with high PLR or high d-NLR (group B) had a shorter RFS (p = 0.006) with lower PLR and low d-NLR (group A). Conclusions The preoperative d-NLR level is an independent risk factor for GIST prognosis. Preoperative PLR and d-NLR can be used as an important index for evaluating the postoperative RFS of GIST. It is expected to predict the recurrence risk of GIST clinically.