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目的 :探讨术前外周血中性粒细胞与淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)在胰腺导管腺癌(pancreatic ductal adenocarcinoma,PDAC)患者根治术后预后评估中的价值。方法 :回顾性分析了2006年1月—2013年7月在解放军总医院接受根治性手术的346例PDAC患者的临床及病理资料。采用四分位数(quartile)法,根据患者术前外周血NLR将患者分为4组(NLR<1.83、1.83≤NLR<2.39、2.39≤NLR<3.22和NLR≥3.22);比较各组患者的临床病理特征及无病生存期(disease-free survival,DFS)和总生存期(overall survival,OS)的差异。采用COX回归模型分析影响PDAC患者根治术后预后的独立影响因素。结果 :PDAC患者根治术前外周血NLR的增高与肿瘤位于胰头、肿瘤直径大、组织分化差、病理T分期和N分期高、临床分期晚以及外周血白细胞计数、血小板计数和中性粒细胞计数增高、淋巴细胞计数和血清白蛋白浓度降低均有关(P值均<0.05)。术前外周血NLR大于Q3(NLR≥3.22)患者的1、3和5年的DFS率和OS率均明显低于其他3组患者。4组患者DFS和OS的差异均具有统计学意义(P值均<0.001);单因素及COX多因素分析结果显示,除肿瘤最大直径、肿瘤分化程度、病理T分期和病理N分期外,术前外周血NLR也是影响PDAC患者根治术后DFS和OS的独立预后因素。结论 :术前外周血NLR可作为PDAC患者根治术后的独立预后因素。
Objective: To investigate the value of preoperative neutrophil-to-lymphocyte ratio (NLR) in prognosis evaluation of patients with pancreatic ductal adenocarcinoma (PDAC). Methods: The clinical and pathological data of 346 patients with PDAC who underwent radical surgery in PLA General Hospital from January 2006 to July 2013 were retrospectively analyzed. The patients were divided into 4 groups according to the quartile NLR (NLR <1.83, 1.83≤NLR <2.39, 2.39≤NLR <3.22, and NLR≥3.22). The patients in each group were compared The difference of clinicopathological features, disease-free survival (DFS) and overall survival (OS) were analyzed. COX regression model was used to analyze the independent influencing factors of prognosis after radical operation in patients with PDAC. Results: The increase of NLR in peripheral blood of patients with PDAC before radical resection was located in the head of pancreas with large tumor diameter, poor tissue differentiation, high T stage and N stage, late clinical stage, peripheral blood leukocyte count, platelet count and neutrophil Increased counts, lymphocyte counts, and decreased serum albumin concentrations (P <0.05). Patients with preoperative NLR greater than Q3 (NLR ≥ 3.22) in 1,3 and 5-year DFS rate and OS rate were significantly lower than the other three groups of patients. The differences of DFS and OS between the four groups were statistically significant (P <0.001). The multivariate analysis of single factor and COX showed that in addition to the maximum tumor diameter, tumor differentiation, pathological T staging and pathological N staging Pre-peripheral blood NLR is also an independent prognostic factor for DFS and OS in patients with PDAC after radical surgery. Conclusion: Preoperative NLR can be used as an independent prognostic factor in patients with PDAC after radical operation.