【作者】 李旋；

【导师】 葛杰；

【作者基本信息】 中南大学 ， 临床医学（专业学位）， 2022， 硕士

【摘要】 目的:探究常见的炎症指标、营养指标、凝血指标与胃癌新辅助化疗疗效和印戒胃癌预后的关系,寻找胃癌新辅助化疗(NAC)疗效和印戒胃癌预后预测因子。方法:1.依据纳入与排除标准,选择在湘雅医院接受术前1周期以上NAC的208例胃癌患者作为研究对象。回顾性归纳整理以上患者的临床人口学资料、肿瘤病理学特征、NAC前炎症指标、凝血指标、营养指标,以肿瘤退缩分级(TRG)判定NAC疗效,采用Logistic多因素回归分析明确NAC疗效的独立预测因子。2.依据纳入与排除标准,选择在湘雅医院胃肠外科接受胃癌根治术的212例印戒胃癌患者作为研究对象。回顾性归纳整理以上患者的临床人口学资料、肿瘤病理学特征、术前炎症指标、凝血指标、营养指标,以5年生存率为研究终点,采用Kaplan-Meier生存分析比较生存率差异,采用Cox比例风险回归模型进行多因素分析,明确印戒胃癌预后的独立预测因子;结果:1.单因素分析显示化疗方案(χ~2=14.227;P=0.007)、白蛋白(ALB)(t=-2.628;P=0.009)、白球比(AGR)(t=-3.224;P=0.001)、预后营养指数(PNI)(t=-2.102;P=0.037)、凝血酶时间(TT)(Z=-2.909;P=0.004)、D-二聚体(Z=-2.760;P=0.006)、是否为印戒胃癌(χ~2=21.398;P<0.001)与NAC疗效显著相关;2.多因素分析显示与以紫杉醇类为基础的方案相比,以奥沙利铂和氟尿嘧啶类为基础的方案NAC疗效更佳(OR:0.395,95%CI:0.176～0.887),非印戒胃癌(OR:5.498,95%CI:2.205～13.710)NAC疗效疗效更佳,化疗前D-二聚体(OR:4.431,95%CI:1.695～11.583)、化疗前TT(OR:0.287,95%CI:0.129～0.638)是NAC疗效的独立预测因子;3.单因素分析显示肿瘤浸润深度(χ~2=49.726;P<0.001)、淋巴结转移(χ~2=30.269;P<0.001)、p TNM分期(χ~2=49.322;P<0.001)、切除范围(χ~2=8.489;P=0.004)、年龄(t=-2.213;P=0.028)、CEA(Z=-3.265;P=0.001)、血小板与淋巴细胞比值(PLR)(Z=-2.196;P=0.028)、淋巴细胞与单核细胞比值(LMR)(Z=-2.226;P=0.026)、白蛋白(ALB)(t=3.284;P=0.001)、预后营养指数(PNI)(t=-3.789;P<0.001)、纤维蛋白原(FIB)(Z=-3.065;P=0.002)与印戒胃癌患者生存状态显著相关;4.多因素分析显示年龄(HR:0.563,95%CI:0.363～0.873)、肿瘤浸润深度(HR:0.226,95%CI:0.098～0.520)、p TNM分期(HR:0.444,95%CI:0.255～0.771)、术前CEA水平(HR:0.597,95%CI:0.386～8.790)、术前LMR水平(HR:1.776,95%CI:1.150～2.741)是印戒胃癌患者预后的独立预测因子。结论:1.NAC前高水平的D-二聚体、较短的TT是胃癌NAC疗效不佳的独立预测因子;2.术前低LMR水平提示印戒胃癌患者预后相对不良,术前低LMR组死亡风险是高LMR组的1.776倍。图3幅,表19个,参考文献83篇更多还原

【Abstract】 Objective:To explore the relationship between common inflammatory indexes,nutritional indexes,coagulation indexes and efficacy of neoadjuvant chemotherapy for gastric cancer and prognosis of signet ring gastric cancer,and to find out the predictive factors of efficacy of neoadjuvant chemotherapy for gastric cancer and prognosis of signet ring gastric cancer.Methods:1.According to the inclusion and exclusion criteria,208gastric cancer patients receiving neoadjuvant chemotherapy more than one cycle before operation in Xiangya Hospital were selected as the research objects.The clinical demographic data,tumor pathological characteristics,inflammation indexes,coagulation indexes and nutritional indexes before the first neoadjuvant chemotherapy of the above patients were retrospectively summarized.The tumor regression grade(TRG)was used to determine the response to neoadjuvant chemotherapy.Logistic multivariate regression analysis was used to determine the independent predictors of the response to neoadjuvant chemotherapy.2.According to the inclusion and exclusion criteria,212 patients with signet ring gastric cancer who underwent radical gastrectomy in gastrointestinal surgery of Xiangya Hospital were selected as the study subjects.The clinical demographic data,tumor pathological features,preoperative inflammation indexes,coagulation indexes and nutritional indexes of the above patients were retrospectively summarized.5-year OS was taken as the end point of the study,Kaplan-Meier survival analysis was used to compare the difference in survival rates,and Cox proportional hazard regression model was used for multivariate analysis to determine the independent prediction index of the prognosis of signet ring gastric cancer.Results:1.Univariate analysis showed that chemotherapy regimen(χ~2=14.227;P=0.007),ALB(t=-2.628;P=0.009),AGR(t=-3.244;P=0.001),PNI(t=-2.102;P=0.037),TT(Z=-2.909;P=0.004),D-dimer(Z=-2.760;P=0.006)and signet ring gastric cancer(χ~2=21.398;P<0.001)were significantly correlated with NAC therapeutic effect;2.Multivariate analysis showed that compared with paclitaxel-based regimens,oxaliplatin and fluorouracil based regimens had better NAC efficacy(OR:0.395,95%CI:0.176-0.887),non-signet-ring gastric cancer had better NAC efficacy(OR:5.498,95%CI:2.205-13.710),D-dimer before first chemotherapy(OR:3.730,95%CI:1.466-9.491)and TT before first chemotherapy(OR:0.216,95%CI:0.093-0.500)were independent predictors of NAC efficacy;3.Univariate analysis showed the depth of tumor invasion(χ~2=49.726;P<0.001),lymph node metastasis(χ~2=30.269;P<0.001),p TNM stage(χ~2=49.322;P<0.001),surgical approach(χ~2=8.489;P=0.004),age(t=-2.213;P<0.028),CEA(Z=-3.265;P=0.001),PLR(Z=-2.196;P=0.028),LMR(Z=-2.226;P=0.026),ALB(t=3.284;P=0.001),PNI(t=-3.789;P<0.001)and FIB(Z=-3.065;P=0.002)were significantly correlated with the survival status of patients;4.Multivariate analysis showed that age(HR:0.563,95%CI:0.363-0.873),tumor invasion depth(HR:0.226,95%CI:0.098-0.520),p TNM stage(HR:0.444,95%CI:0.255-0.771),preoperative CEA level(HR:0.597,95%CI:0.386-8.790),and preoperative LMR level(HR:1.776,95%CI:1.150-2.741)were independent prognostic factors for patients with signet ring gastric cancer.Conclusion:1.High levels of D-dimer and short TT before NAC are independent predictors of poor NAC efficacy in gastric cancer;2.Low preoperative LMR level indicates poor prognosis in signet ring gastric cancer patients,the risk of death in low preoperative LMR group is 1.776 times higher than that in high preoperative LMR group.更多还原