摘要目的:研究系统免疫炎症指数(SII)在胰腺导管腺癌患者Whipple术后总体生存率中的预测价值。方法:回顾性分析2010年1月1日至2017年12月31日在郑州大学第一附属医院进行Whipple术的胰腺导管腺癌患者临床资料，计算SII值。取SII最佳截断值为900，以900为界值将所有患者分为低SII组(SII≤900)和高SII组(SII>900)，应用Kaplan-Meier法绘制生存曲线，采用log-rank检验对两组患者的总生存时间进行分析，采用Cox风险回归模型对各项临床病理参数进行单因素分析，并对具有统计学意义的指标进行多因素分析。结果:共纳入135例患者，其中男性78例，女性57例，年龄28.0～76.0(56.6±8.8)岁。低SII组纳入92例，年龄(56.9±9.2)岁，男性53例，女性39例；高SII组纳入43例，年龄(56.1±7.9)岁，男性25例，女性18例。低SII组和高SII组两组中位生存时间分别为32.7个月(95% CI：28.4～37.0)和24.4个月(95% CI：21.4～27.4)，低SII组胰腺导管腺癌患者生存率高于和高SII组，差异有统计学意义( P<0.05)。在单因素生存分析中，胰腺导管腺癌患者术后总生存期与高SII( HR＝2.047，95% CI：1.354～3.096)、R 1切缘( HR＝2.595，95% CI：1.663～4.048)、淋巴结阳性率>20%( HR＝3.244, 95% CI：1.888～5.573)、区域淋巴结(N1)( HR＝3.061，95% CI：1.993～4.702)有关(均 P<0.05)。多因素Cox回归分析显示，高SII( HR＝1.672，95% CI：1.094～2.555)、R 1切缘( HR＝2.167，95% CI：1.274～3.685)、淋巴结阳性率>20%( HR＝2.631，95% CI：1.309～5.285)是影响胰腺导管腺癌患者Whipple术后总生存期的独立危险因素( P<0.05)。 结论:SII是胰腺导管腺癌患者术前可获得的独立预后因子，在预测胰腺导管腺癌患者行Whipple术后总生存期方面有一定指导意义。

abstractsObjective:To study the predictive value of the systemic immune inflammation index (SII) on the overall survival rate of patients after Whipple surgery for pancreatic ductal adenocarcinoma (PDAC).Methods:The clinical data of patients with PDAC who underwent Whipple surgery at the First Affiliated Hospital of Zhengzhou University from January 1, 2010 to December 31, 2017 were retrospectively analyzed, and the SII value was calculated. The best cut-off value of SII was 900, and all patients were divided into the low SII group (SII≤900) and the high SII group (SII>900) using 900 as the dividing point. The Kaplan-Meier method was used to draw survival curves and the log-rank test was used. The overall survival of the two groups of patients were analyzed. The Cox risk regression model was used to perform univariate analysis of the various clinicopathological parameters, and multivariate analysis for the statistically significant indicators.Results:Of 135 patients enrolled into this study, there were 78 males and 57 females, aged 28.0-76.0 (56.6±8.8) years. There were 92 patients in the low SII group, aged (56.9±9.2) years with 53 males and 39 females; and 43 patients in the high SII group, aged (56.1±7.9) years, with 25 males and 18 females. The median survival of the low SII group and the high SII group were 32.7 months (95% CI: 28.4-37.0) and 24.4 months (95% CI: 21.4-27.4), respectively. The survival of patients with PDAC in the low SII group was significantly higher than that in the high SII group ( P<0.05). On univariate survival analysis, postoperative overall survival of patients with PDAC was significantly associated with high SII ( HR=2.047, 95% CI: 1.354-3.096), R 1 margin ( HR=2.595, 95% CI: 1.663-4.048), a positive rate of lymph node>20% ( HR=3.244, 95% CI: 1.888-5.573), and positive regional lymph node (N1) ( HR=3.061, 95% CI: 1.993-4.702), all P<0.05. Multivariate Cox regression analysis showed that high SII ( HR=1.672, 95% CI: 1.094-2.555), R 1 resection margin ( HR=2.167, 95% CI: 1.274-3.685), and a positive rate of lymph node>20% ( HR=2.631, 95% CI: 1.309-5.285) to be independent risk factors affecting overall survival ( P<0.05). Conclusion:SII was an independent prognostic factor available before surgery for patients with PDAC. It has some guiding significance in predicting overall survival in patients after Whipple surgery for PDAC.