免疫炎症因子在肝内胆管癌中的预测价值

刘桂玲; 窦杰; 孟慧娟; 马炳奇

doi:10.3969/j.issn.1001-5256.2023.09.030

免疫炎症因子在肝内胆管癌中的预测价值

DOI: 10.3969/j.issn.1001-5256.2023.09.030

刘桂玲¹,
窦杰¹,
孟慧娟²,
马炳奇^1, , ,

1.
潍坊医学院附属医院，肝胆胰外科，山东潍坊 261031
2.
潍坊医学院附属医院，皮肤科，山东潍坊 261031

基金项目:

潍坊市科学技术发展计划（医学类） (2022YX026);

潍坊医学院附属医院科研创新计划项目 (2022BSQD07);

山东省医药卫生科技发展计划项目 (202004011537)

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：刘桂玲负责查阅文献，撰写文章；窦杰参与论文起草；孟慧娟参与论文起草，修改文章关键内容；马炳奇负责提出论文思路，参与论文指导，修改文章并最后定稿。

详细信息

通信作者:
马炳奇， mabingqi@126.com （ORCID： 0000－0001－9314－6559）

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出版历程
- 收稿日期: 2023-03-28
- 录用日期: 2023-04-30
- 出版日期: 2023-09-19

Value of immune－inflammatory factors in predicting intrahepatic cholangiocarcinoma

1.
Department of Hepatopancreatobiliary Surgery, Affiliated Hospital of Weifang Medical University，Weifang，Shandong 261031，China
2.
Department of Dermatology，Affiliated Hospital of Weifang Medical University，Weifang，Shandong 261031，China

Research funding:

Weifang Science and Technology Development Program （Medical Science） (2022YX026);

Scientific Research and Innovation Project of Affiliated Hospital of Weifang Medical University (2022BSQD07);

Medical and Health Science and Technology Development Plan of Shandong Province (202004011537)

More Information

Corresponding author: MA Bingqi， mabingqi@126.com （ORCID： 0000－0001－9314－6559）

摘要

摘要: 肝内胆管癌（ICC）是最常见的原发性肝脏恶性肿瘤之一，在过去20年中发病率持续上升。手术切除是ICC的主要治疗方式，但超半数患者在初诊时已失去手术机会，只能选择局部区域治疗或系统治疗。目前ICC的治疗效果并不理想。在ICC和其他实体肿瘤中，已发现一些炎症指标可能有效反映肿瘤内部的炎症状态，这些免疫炎症因子（IIF）与肿瘤进展及预后指标存在着明显的相关性，其均是基于血常规、C反应蛋白、白蛋白和肿瘤标志物等血液学指标计算得出，并可以分为三大类：直接炎症因子、肿瘤标志物和联合炎症因子。经过对比分析发现，联合炎症因子在ICC患者预后中的预测价值优于直接炎症因子和肿瘤标志物。推荐使用IIF中的炎症和肿瘤指标预后评分、全身炎症评分或全身炎症反应指数作为ICC患者生存预后的评分系统。
- 胆管上皮癌 /
- 生物标记，肿瘤 /
- 预后
Abstract: Intrahepatic cholangiocarcinoma （ICC） is one of the most common primary liver malignancies， with an increasing incidence rate in the past two decades. Surgical resection is the main treatment method for ICC， but more than half of the patients have lost the opportunity for surgery at the time of initial diagnosis， with the only choice of locoregional or systemic treatment. At present， there is still a lack of satisfactory treatment outcomes for ICC. In ICC and other solid tumors， it has been found that some immune－inflammatory factors （IIFs） can effectively reflect the inflammatory state within the tumor， and these IIFs are significantly associated with tumor progression and prognostic markers. These IIFs are all calculated based on hematological parameters such as routine blood test results， C－reactive protein， albumin， and tumor markers， and they can be classified into three categories， i.e.， direct inflammatory factors， tumor markers， and combined inflammatory factors. Comparative analysis has shown that combined inflammatory factors has a better value than direct inflammatory factors and tumor markers in predicting the prognosis of ICC patients. It is recommended to use prognostic inflammatory and tumor score， systemic inflammation score， and systemic inflammation response index as the scoring systems for evaluating the survival and prognosis of ICC patients.
- Cholangiocarcinoma /
- Biomarkers， Tumor /
- Prognosis

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表 1 ICC中IIF的分类、计算标准及截断值

Table 1. The classification， calculation criteria and cutoff value of IIF in ICC

IIF	计算标准	截断值
直接炎症因子
NLR^{［17，19，24］}	中性粒细胞计数（10⁹/L）/淋巴细胞计数（10⁹/L）	2.94^［17］；3.00^［19］；5.0^［24］
PLR^{［17，19，25］}	血小板计数（10⁹/L）/淋巴细胞计数（10⁹/L）	130.59^［17］；90.0^［19］；150^［25］
LMR^{［17，19，23］}	淋巴细胞计数（10⁹/L）/单核细胞计数（10⁹/L）	3.62^［17］；2.70^［19］；4.45^［23］
PII^［19］	中性粒细胞计数（10⁹/L）×单核细胞计数（10⁹/L）/淋巴细胞计数（10⁹/L）	1.50
SII^［20］	中性粒细胞计数（10⁹/L）×血小板计数（10⁹/L）/淋巴细胞计数（10⁹/L）	867.4
IS^［21］	0分：NLR<1.93且LMR≥4.78 1分：NLR≥1.93且LMR≥4.78/NLR<1.93且LMR<4.78 2分：NLR≥1.93且LMR<4.78
肿瘤标志物
CA19－9^{［18－19，23］}		39.0^［18］；76.0^［19］；89.0^［23］
CEA^{［18－19，25］}		5.00^［18］；4.50^［19］；7.0^［25］
CA242^［19］		30.0
Fer^［19］		150
联合炎症因子
PNI^{［16－17］}	Alb（g/L）+5×淋巴细胞计数（10⁹/L）	48.25^［16］；36.7^［17］
GPS^［17］	0分：CRP≤10 mg/L且Alb≥35 g/L 1分：CRP≤10 mg/L且Alb<35 g/L/CRP>10 mg/L且Alb≥35 g/L 2分：CRP>10 mg/L且Alb<35 g/L
mGPS^［17］	0分：CRP≤10 mg/L 1分：CRP>10 mg/L且Alb≥35 g/L 2分：CRP>10 mg/L且Alb<35 g/L
PI^［17］	0分：CRP≤10 mg/L且WBC≤11×10⁹/L 1分：CRP≤10 mg/L且WBC>11×10⁹/L/CRP>10 mg/L且WBC≤11×10⁹/L 2分：CRP>10 mg/L且WBC>11×10⁹/L
PITS^［22］	1级：PII<1.5且CA19－9<76.0 U/mL 2级：PII≥1.5，CA19－9<76.0 U/mL/PII<1.5且CA19－9≥76.0 U/mL 3级：PII≥1.5且CA19－9≥76.0 U/mL
SIS^［23］	1级：CA19－9<89 U/mL且LMR≥4.45 2级：CA19－9≥89 U/mL且LMR≥4.45/CA19－9<89 U/mL且LMR<4.45 3级：CA19－9≥89 U/mL且LMR<4.45
SIR^［24］	①CA19－9≥500 IU/mL；②NLR≥5；③CRP≥5 mg/L 1级：均不满足上述条件 2级：只有1项满足上述条件 3级：2～3项满足上述条件
PPS^［25］	0分：CEA≤7.0 ng/mL；Alb≥35 g/L；CRP≤0.5 mg/dL；PLR≤150 1分：CEA>7.0 ng/mL；Alb<35 g/L；CRP>0.5 mg/dL；PLR>150 PPS为上述4项指标的总和
注：PII，预后炎症指数；IS，炎症评分；CA19－9，糖类抗原19－9；CEA，癌胚抗原；CA242，糖类抗原242；Fer，铁蛋白；PNI，营养预后指标；mGPS，修正的GPS评分；SIR，全身炎症反应指数；PPS，术前预后评分。

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