标题：腹腔镜胆囊癌根治术后患者的PP-NLR、GPS评分及临床意义

      作者：徐海煜 1，刘军 2，葛鹏 2    西安市中心医院急诊外科 1、普外科 2，陕西 西安 710003

      卷次： 2021年32卷19期

      【摘要】 目的 分析腹腔镜胆囊癌根治术后患者的中性粒细胞-淋巴细胞比值(PP-NLR)和格拉斯哥预后评分(GPS)，并探讨其临床意义。方法 回顾性分析2014年5月至2017年6月于西安市中心医院行腹腔镜胆囊癌根治术的 126例胆囊癌患者的诊疗资料。据患者术前检测结果计算 PP-NLR、GPS评分，分别对其进行 PP-NLR分组[PP-NLR0组(PP-NLR<5，92例)、PP-NLR1组(PP-NLR≥5，34例)]和GPS分组{GPS0组[C反应蛋白(CRP)≤10 mg/L且白蛋白(ALB)≥35 g/L，38例]、GPS1组(CRP＞10 mg/L且ALB≥35 g/L/CRP≤10 mg/L且ALB＜35 g/L，61例)、GPS2组(CRP>10 mg/L且Alb<35 g/L，27例)}。比较以上各组患者的临床特征和术后3年生存率，采用单因素分析影响患者预后的因素，并采用Cox比例风险模型进行多因素分析，评估 PP-NLR、GPS评分对患者预后的预测价值。结果 不同PP-NLR分组患者的肿瘤大小、肿瘤分化、淋巴结转移、肿瘤TNM分期比较差异均有统计学意义(P<0.05)；不同GPS分组患者的淋巴结转移、肿瘤TNM分期比较差异均有统计学意义(P<0.05)。PP-NLR0组患者术后3年生存率为80.43%，明显高于PP-NLR1组的58.82%，差异有统计学意义(P<0.05)；GPS0组患者术后3年生存率为84.21%，明显高于GPS1组的63.93%和GPS2组的37.04%，且GPS1组患者术后3年生存率明显高于GPS2组，差异均有统计学意义(P<0.05)；单因素分析结果显示：肿瘤分化、淋巴结转移、肿瘤TNM分期、PP-NLR及GPS评分与患者预后密切相关(P<0.05)；COX多因素分析结果显示：肿瘤TNM分期、PP-NLR、GPS评分是影响患者预后的独立危险因素(P<0.05)。结论 PP-NLR、GPS评分对评估腹腔镜胆囊癌根治术后患者的预后有一定的临床价值。
      【关键词】 胆囊癌；腹腔镜；胆囊癌根治术；中性粒细胞-淋巴细胞比值；格拉斯哥评分；预后
      【中图分类号】 R735.8 【文献标识码】 A 【文章编号】 1003—6350（2021）19—2507—04

PP-NLR and GPS scores and clinical significance of patients after laparoscopic radical resection of gallbladdercancer.
XU Hai-yu 1, LIU Jun 2, GE Peng 2. Emergency Surgery 1, General Surgery 2, Xi'an Central Hospital, Xi'an 710003,Shaanxi, CHINA
【Abstract】 Objective To analyze the neutrophil-lymphocyte ratio (PP-NLR) and Glasgow prognostic score(GPS) of patients after laparoscopic radical resection of gallbladder cancer, and to explore their clinical significance.Methods A retrospective analysis was conducted on the clinical data of 126 patients with gallbladder cancer who un-derwent laparoscopic radical resection of gallbladder cancer in Xi'an Central Hospital from May 2014 to June 2017. Ac-cording to the preoperative test results, the PP-NLR and GPS scores of the patients were calculated, then they were dividedinto PP-NLR groups and GPS groups. The PP-NLR groups included PP-NLR0 group (PP-NLR<5, 92 cases), PP-NLR1group (PP-NLR≥5, 34 cases), and GPS groups included GPS0 group [C-reactive protein (CRP) ≤10 mg/L and albumin(ALB) ≥35 g/L, 38 cases], GPS1 group (CRP>10 mg/L and ALB≥35 g/L /CRP≤10 mg/L and ALB<35 g/L, 61 cases),GPS2 group (CRP>10 mg/L and Alb<35 g/L, 27 cases). The clinical characteristics and 3-year postoperative survivalrate were compared between the above groups, univariate analysis was used to analyze the factors affecting the progno-sis of the patients, and the Cox proportional hazard model was used for multi-factor analysis to evaluate the predictivevalue of PP-NLR and GPS scores on the prognosis of patients. Results There were statistically significant differencesin tumor size, tumor differentiation, lymph node metastasis, and tumor TNM staging among different PP-NLR groups(P<0.05). There were statistically significant differences in lymph node metastasis and tumor TNM staging among pa-tients with different GPS grouping (P<0.05). The 3-year postoperative survival rate was 80.43% in the PP-NLR0 group,which was significantly higher than 58.82% in the PP-NLR1 group, and the difference was statistically significant (P<0.05). The 3-year postoperative survival rate of the GPS0 group was 84.21%, which was significantly higher than that ofthe GPS1 group (63.93%) and the GPS2 group (37.04%), and the 3-year postoperative survival rate was significantlyhigher in the GPS1 group than in the GPS2 group (P<0.05). The results of univariate analysis showed that tumor dif-ferentiation, lymph node metastasis, tumor TNM staging, PP-NLR and GPS score were closely related to the progno-sis of patients (P<0.05). Cox multivariate analysis results showed that tumor TNM staging, PP-NLR score, and GPSscore were independent risk factors that affect the prognosis of patients (P<0.05). Conclusion PP-NLR and GPSscores have a certain clinical value in evaluating the prognosis of patients after laparoscopic radical resection of gall-bladder cancer.
      【Key words】 Gallbladder cancer; Laparoscopy; Radical resection of gallbladder cancer; Neutrophil-lymphocyteratio; Glasgow sc