Analysis of clinical characteristics and risk of metastasis of 352 patients with pancreatic cancer in the tropical region of Hainan Province
ZOU Yan and HE Zhi-jun are contributed equally to this work
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摘要:
目的 分析海南热带地区胰腺癌患者临床特征, 为及时发现、合理诊治胰腺癌提供依据。 方法 基于电子病历(electronic medical record, EMR)系统收集胰腺癌患者临床资料, 应用SPSS 22.0软件进行统计学分析。 结果 352例患者男女性别比1:0.66, 年龄(65±13)岁; 黄疸占40.3%、腹痛36.1%;无转移占33.5%、有转移66.5%。百分位数法显示淋巴细胞及其比率、葡萄糖(glucose, Glu)、丙氨酸氨基转移酶(alanine aminotransferase, ALT)、天冬氨酸氨基转移酶(aspartic acid aminotransferase, AST)、直接胆红素(direct bilirubin, DB)、间接胆红素(indirect bilirubin, IB)、癌胚抗原(carcinogenic antigen, CEA)、肿瘤标志物糖链抗原(tumor marker sugar chain antigen 19-9, CA19-9)与正常参考值范围比较有差异。Mann-Whitney U检验显示白细胞、中性粒细胞及其比率、中性粒细胞与淋巴细胞比值(ratio of neutrophils to lymphocytes, NLR)、ALT、AST、DB、IB、CEA组间有差异(均有P < 0.05)。二分类Logistic回归分析模型显示NLR≥3.7是NLR < 3.7时发生转移风险的4.958(1.896~12.964)倍, IB与转移风险呈负关联。 结论 65岁左右具有黄疸、腹痛症状者, 淋巴细胞及其比率、Glu、ALT、AST、DB、IB、CEA、CA19-9检查有助于胰腺癌的及时发现; NLR及IB对胰腺癌的合理治疗具有指导意义。 Abstract:Objective To analyze the clinical characteristics of patients with pancreatic cancer in tropical Hainan province and provide the evidence for timely discovering and giving reasonable diagnosis and treatment of pancreatic cancer. Methods Based on electronic medical record(EMR), the clinical data of pancreatic cancer patients were collected. SPSS software version 22.0 was used to conduct statistical analyses of the data. Results The male to female ratio of 352 patients was 1: 0.66. The age range was 20-95 years old, and the average age was(65±13) years. Among these patients, the jaundice and the abdominal pain accounted for 40.3% and 36.1% respectively. The non-metastasis and metastasis accounted for 33.5% and 66.5%, respectively. The results of percentile method indicated that lymphocytes and their ratio, glucose(Glu), alanine aminotransferase(ALT), aspartic acid aminotransferase(AST), direct bilirubin(DB), indirect bilirubin(IB), carcinogenic antigen(CEA), and tumor marker sugar chain antigen 19-9(CA19-9) were different from normal reference range. Mann-Whitney U test found that there were differences in white blood cell, neutrophil and its ratio, NLR, ALT, AST, DB, IB and CEA between groups(all P < 0.05). The results of binary logistic regression analysis showed that the risk of metastasis when NLR≥3.7 was 4.958 times(1.896-12.964) compared to that when NLR < 3.7. IB was negatively associated with metastatic risk. Conclusions For people around 65 years old with symptoms of jaundice and abdominal pain, the number and ratio of lymphocyte, Glu, transferase, bilirubin, CEA and CA19-9 are helpful for timely detection of pancreatic cancer. In addition, NLR and IB values may have guiding significance for the rational treatment of pancreatic cancer. -
Key words:
- EMR /
- Pancreatic cancer /
- Clinical characteristics /
- Metastasis risk /
- Tropical area
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表 1 胰腺癌患者血液检查结果与参考值的比较
Table 1. Comparison of blood test results in pancreatic cancer patients and reference values
检查指标 M 百分位数法值的范围 医学参考值 白细胞(109/L) 7 5~10 4~10 中性粒细胞数(109/L) 5 4~7 2~7 中性粒细胞比率(%) 69 61~77 50~70 淋巴细胞数(109/L) 1.34 0.95~1.81 1.32~3.57 淋巴细胞比率(%) 19 13~27 20~40 NLR 3.7 2.3~6.2 - CEA(ng/ml) 6.36 2.84~21.56 0.50~9.70 AFP(ng/ml) 2.79 1.74~4.13 1.09~20.00 Glu(mmol/L) 5.78 4.91~7.09 3.89~6.11 ALT(U/L) 44 20~102 5~40 AST(U/L) 40 23~101 5~40 球蛋白(g/L) 29 25~33 20~35 DB(μmol/L) 6 3~87 0~6 IB(μmol/L) 10.9 6.8~37.5 1.7~17.0 CA19-9(U/ml) 345.5 23.1~1 200.0 2.0~37.0 
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表 2 胰腺癌有无转移患者血液检查结果的比较
Table 2. Comparison of blood test results in pancreatic cancer patients with or without metastasis
检查指标 无转移组M 有转移组M Z值 P值 白细胞计数(109/L) 6.74 7.46 -2.082 0.037 中性粒细胞数(109/L) 3.59 5.54 -8.602 < 0.001 中性粒细胞比率(%) 64.00 71.50 -5.580 < 0.001 淋巴细胞数(109/L) 1.40 1.33 -0.402 0.688 淋巴细胞比率(%) 17.80 19.40 -0.416 0.677 NLR 2.52 4.18 -5.758 < 0.001 Glu(mmol/L) 5.90 5.74 -0.462 0.644 ALT(U/L) 64.50 35.78 -2.680 0.007 AST(U/L) 56.50 37.00 -2.053 0.040 球蛋白(g/L) 28.70 28.90 -0.942 0.346 DB(μmol/L) 27.83 5.10 -2.064 0.039 IB(μmol/L) 14.80 9.40 -2.977 0.003 CEA(ng/ml) 4.28 7.33 -4.125 < 0.001 CA19-9(U/ml) 168.83 400.00 -1.425 0.154 AFP(ng/ml) 2.43 2.80 -0.668 0.504
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表 3 影响胰腺癌转移相关因素的Logistic回归分析模型
Table 3. Logistic regression analysis of related factors affecting metastasis of pancreatic cancer
相关因素 β值 OR(95% CI)值 P值 NLR < 3.7=0 1.000 ≥3.7=1 1.601 4.958(1.896~12.964) 0.001 IB(μmol/L) 正常=0 1.000 异常=1 -1.119 0.327(0.133~0.801) 0.015
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