| 闫可,魏菀怡,杨洁,等.系统免疫炎症指数联合临床分期对食管癌患者预后的预测价值[J].中华放射医学与防护杂志,2022,42(1):25-31.Yan Ke,Wei Wanyi,Yang Jie,et al.Predictive value of systemic immune-inflammation index combined with clinical staging for prognosis of esophageal cancer patients[J].Chin J Radiol Med Prot,2022,42(1):25-31 |
| 系统免疫炎症指数联合临床分期对食管癌患者预后的预测价值 |
| Predictive value of systemic immune-inflammation index combined with clinical staging for prognosis of esophageal cancer patients |
| 投稿时间：2021-08-23 |
| DOI：10.3760/cma.j.cn112271-20210823-00340 |
| 中文关键词: 食管肿瘤 放射治疗 系统免疫炎症指数 临床分期 预后 |
| 英文关键词:Esophageal neoplasms Radiotherapy Systemic immune-inflammation index(SII) Clinical staging Prognosis |
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| 中文摘要: |
| 目的 探讨系统免疫炎症指数（SII）与接受根治性放疗的食管癌患者预后的关系，并联合TNM分期预测患者预后。方法 回顾分析河北医科大学第四医院放疗科2014年至2016年收治的248例食管癌患者临床资料，其中，男146例，女102例；中位年龄67岁；同期化疗134例，单纯放疗114例。计算患者放疗前SII，运用受试者工作特征（ROC）曲线确定SII的最佳临界值，分为低SII组和高SII组。生存分析采用Kaplan-Meier法，多因素分析采用Cox比例风险模型。比较不同水平SII联合TNM分期患者的预后以及对生存的预测价值。结果 根据ROC曲线确定治疗前SII最佳临界值为740.80，将全组患者分为低SII组（<740.80，150例）和高SII组（≥740.80，98例）。低SII组患者放疗后客观缓解率显著高于高SII组（86.0%∶75.5%，χ2=4.39，P=0.036）。低SII组和高SII组患者1、3、5年总生存（OS）率分别为78.6%、45.6%、32.3%和71.0%、28.3%、16.4%（χ2=11.22，P=0.001），两组1、3、5年无进展生存（PFS）率分别为67.0%、36.9%、32.0%和45.5%、17.5%、12.5%（χ2=15.38，P<0.001）。多因素分析显示TNM分期、治疗方式和放疗前SII为患者OS及PFS的独立影响因素（HR=1.39~1.60，P<0.05）。放疗前SII较低且临床分期偏早患者的预后优于其他亚组（χ2=13.68、13.43，P=0.001）。SII联合TNM分期预测生存的曲线下面积（AUC）（0.70）高于SII （0.63）及TNM分期（0.62）（Z=2.48、2.57，P<0.05）。结论 SII对于食管癌放疗预后生存有较高的预测价值，放疗前SII越高患者预后越差，SII联合TNM分期可提高预测准确性。 |
| 英文摘要: |
| Objective To investigate the relationship between systemic immune-inflammation index (SII) and the prognosis of esophageal cancer patients treated with radical radiotherapy and to predict the prognosis of the patients using the SII combined with clinical staging.Methods A retrospective analysis was conducted for 248 patients with esophageal cancer who were admitted to the Department of Radiotherapy in the Fourth Hospital of Hebei Medical University between 2014 and 2016. These patients included 146 males and 102 females, with a median age of 67 years. Among them, 134 patients received concurrent chemotherapy and 114 patients received radiotherapy alone. The SII before radiotherapy was defined as platelet count×neutrophil count/lymphocyte count. The patients were divided into a low-SII group and a high-SII group according to the optimal cutoff value of pretreatment SII determined by the receiver operating characteristics (ROC) curve. Survival analysis was calculated using the Kaplan-Meier method, and the Cox proportional hazards model was used for multivariate analysis. For these patients, the prognosis effects and the predictive value for survival of different SII levels combined with TNM staging were compared.Results According to the ROC curves, the optimal cutoff value of SII before radiotherapy was 740.80. Based on this number, the patients were divided into a low-SII group (< 740.80, 150 cases) and a high-SII group (≥ 740.80, 98 cases). The objective response rate of the low-SII group was significantly higher than that of the high-SII group (86.0% vs 75.5%, χ2=4.39, P=0.036). The 1-, 3-, and 5-year overall survival (OS) rates of the low-SII group were 78.6%, 45.6%, and 32.3%, respectively. These rates were significantly higher than the corresponding rates of the high-SII group, which were 71.0%, 28.3%, and 16.4% (χ2=11.22, P=0.001), respectively. Moreover, the 1-, 3- and 5-year progression-free survival (PFS) rates of the low-SII group were 67.0%, 36.9%, and 32.0%, respectively. Again, these rates were significantly higher than those of the high-SII group, which were 45.5%, 17.5%, and 12.5% (χ2=15.38, P < 0.001), respectively. Multivariate analysis showed that TNM staging, treatment method, and SII were independent prognostic factors for OS and PFS (HR=1.39-1.60, P < 0.05). Patients with low SII and early clinical staging had a better prognosis than other subgroups (χ2=13.68, 13.43, P=0.001). The area under curve (AUC) of SII combined with TNM staging (0.70) was higher than that of SII (0.63) and TNM staging (0.62) (Z=2.48, 2.57, P < 0.05).Conclusions Pretreatment SII has a high predictive value for the prognosis of esophageal cancer after radiotherapy, and higher SII indicates a worse prognosis. Thus, combining SII with TNM staging can improve the prediction accuracy of the prognosis of esophageal cancer patients. |
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