应用术前外周血NLR,dNLR,PLR及LMR预测梗阻性左半结肠癌患者预后
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摘要
目的探讨术前外周血中中性粒细胞/淋巴细胞比值(NLR)、间接中性粒细胞/淋巴细胞比值(dNLR)、血小板/淋巴细胞比值(PLR)、淋巴细胞/单核细胞比值(LMR)与急诊手术组(ES组)和肠道金属支架置入后择期手术组(SEMS组)的梗阻性左半结肠癌患者预后的关系,评估其对预后的预测价值。方法回顾性分析88例梗阻性左半结肠癌患者的临床病理资料和随访资料,采用Kaplan-Meier生存分析ES组和SEMS组3年无瘤生存率的差别,比较2组患者术前不同时期外周血中NLR,dNLR,PLR和LMR的比值,通过受试者工作特征曲线(ROC曲线)确定NLR,dNLR,PLR和LMR预测3年无瘤生存率的最佳分界点及预测效能,并根据此节点将患者分为高比值组和低比值组。采用Kaplan-Meier生存分析,单因素及多因素Cox回归进一步分析影响2组梗阻性左半结肠癌患者预后的独立危险因素。结果 SEMS组和ES组3年无瘤生存时间分别为(28.40±1.91),(27.82±1.88)月,差别无统计学意义(P>0.05)。SEMS组支架置入前患者外周血中NLR,PLR平均值明显高于SEMS组(P=0.046,P=0.042)。ES组术前患者外周血中NLR平均值明显高于SEMS组(P=0.015)。ES组术前外周血中NLR和dNLR能有效预测术后3年无瘤生存率,ROC曲线下面积(AUC)分别为0.570和0.632;其中NLR的最佳分界点为19.57,dNLR的最佳分界点为1.58。ES组的CEA表达量(P=0.044)、肿瘤大小(P=0.013)和术前外周血NLR比值是影响术后3年无瘤生存率的危险因素。多因素分析发现,术前外周血中NLR≥19.57是影响ES患者术后3年无瘤生存率的独立危险因素(HR=7.412,95%CI=1.874～29.314)。SEMS组患者的肿瘤浸润深度是影响预后的独立危险因素(P=0.002,HR=10.837,95%CI=2.377～49.401)。结论术前外周血中NLR是影响ES梗阻性左半结肠癌患者预后的独立危险因素,而肿瘤浸润深度是影响SEMS梗阻性左半结肠癌患者预后的独立危险因素。
Objective To explore the role and efficacy of preoperative neutrophil-lymphocyte ratio(NLR), derived neutrophil-lymphocyte ratio(dNLR), platelet-lymphocyte ratio(PLR) and lymphocyte-monocyte ratio(LMR) in prediction of disease-free survival for obstructive left-side colorectal cancer patients who receive emergency surgery(ES) or self-expandable metal stent(SEMS) insertion followed with elective surgery. Methods The clinicopathological data and follow-up data of 88 patients with obstructive left colon cancer were analyzed retrospectively. The difference in the 3-year disease free survival rate between ES and SEMS was analyzed by Kaplan-Meier survival. The ratio of NLR, dNLR, PLR and LMR in the peripheral blood were compared between ES and SEMS group, and the optimal cut-off point was confirmed by receiver operating characteristic curve(ROC curve). Finally, the patients were divided into high ratio group and low ratio group according to the optimal cut-off point. Kaplan-Meier survival analysis, single factor and multiple factor Cox regression were used to further analyze the independent risk factors affecting the prognosis of ES and SEMS group with obstructive left-side colorectal cancer. Results The 3-year disease-free survival time of SEMS group was(28.40±1.91) months, while the 3-year disease-free survival time of ES group was(27.82±1.88) months(P>0.05). The mean values of NLR and PLR in the SEMS group before implantation were significantly higher than they were before surgery(P=0.046, P=0.042). The mean value of NLR in the ES group was significantly higher than that of SEMS group before surgery(P=0.015). The NLR and dNLR in peripheral blood of ES group could effectively predict the 3-year disease free survival(3-year DFS), the area under the ROC curve(AUC) were
Objective To explore the role and efficacy of preoperative neutrophil-lymphocyte ratio(NLR), derived neutrophil-lymphocyte ratio(dNLR), platelet-lymphocyte ratio(PLR) and lymphocyte-monocyte ratio(LMR) in prediction of disease-free survival for obstructive left-side colorectal cancer patients who receive emergency surgery(ES) or self-expandable metal stent(SEMS) insertion followed with elective surgery. Methods The clinicopathological data and follow-up data of 88 patients with obstructive left colon cancer were analyzed retrospectively. The difference in the 3-year disease free survival rate between ES and SEMS was analyzed by Kaplan-Meier survival. The ratio of NLR, dNLR, PLR and LMR in the peripheral blood were compared between ES and SEMS group, and the optimal cut-off point was confirmed by receiver operating characteristic curve(ROC curve). Finally, the patients were divided into high ratio group and low ratio group according to the optimal cut-off point. Kaplan-Meier survival analysis, single factor and multiple factor Cox regression were used to further analyze the independent risk factors affecting the prognosis of ES and SEMS group with obstructive left-side colorectal cancer. Results The 3-year disease-free survival time of SEMS group was(28.40±1.91) months, while the 3-year disease-free survival time of ES group was(27.82±1.88) months(P>0.05). The mean values of NLR and PLR in the SEMS group before implantation were significantly higher than they were before surgery(P=0.046, P=0.042). The mean value of NLR in the ES group was significantly higher than that of SEMS group before surgery(P=0.015). The NLR and dNLR in peripheral blood of ES group could effectively predict the 3-year disease free survival(3-year DFS), the area under the ROC curve(AUC) were
引文
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[13] 庄肃非,孟光冉,王恩龙,等. 中性粒细胞/淋巴细胞比值与结直肠癌临床病理特征的关系[J]. 宁夏医科大学学报,2015,37(10):1210-1212.
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[16] 徐燕梅,崔天祥,张晓晶,等. 外周血单核细胞数量与肺癌放疗近,远期疗效的相关性分析[J]. 中华肺部疾病杂志(电子版),2014,7(2):29-33.
[17] Sabbagh C,Chatelain D,Trouillet N,et al. Does use of a metallic colon stent as a bridge to surgery modify the pathology data in patients with colonic obstruction? A case-matched study[J]. Surg Endosc,2013,27(10):3622-3631.
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[3] Gainant A. Emergency management of acute colonic cancer obstruction[J]. J Visc Surg,2012,149(1):3-10.
[4] Tekkis P P,Kinsman R,Thompson M R,et al. The association of coloproctology of great britain and ireland study of large bowel obstruction caused by colorectal cancer[J]. Annals Surgery,2004,240(1):76-81.
[5] Govindarajan A,Naimark D,Coburn N G,et al. Use of colonic stents in emergent malignant left colonic obstruction: a Markov chain Monte Carlo decision analysis[J]. Dis Colon Rectum,2007,50(11):1811-1824.
[6] Baniyash M,Sade-Feldman M,Kanterman J. Chronic inflammation and cancer: suppressing the suppressors[J]. Cancer Immunol Immunother,2014,63(1):11-20.
[7] Gu L,Li H,Chen L,et al. Prognostic role of lymphocyte to monocyte ratio for patients with cancer: evidence from a systematic review and meta-analysis[J]. Oncotarget,2016,7(22):31926-31942.
[8] Tao Y,Ding L,Yang G G,et al. Predictive impact of the inflammation-based indices in colorectal cancer patients with adjuvant chemotherapy[J]. Cancer Medicine,2018, 2045-7634:1-11[Epub ahead of prine].
[9] Lin B Q,Wang R L,Li Q X,et al. Investigation of treatment methods in obstructive colorectal cancer[J]. J BUON,2015,20(3):756-761.
[10] Gorissen K J,Tuynman J B,Fryer E,et al. Local recurrence after stenting for obstructing left-sided colonic cancer[J]. Br J Surg,2014,100(13):1805-1809.
[11] 陈小林,姚国强,刘剑荣. 术前外周血中NLR、d-NLR、PLR和LMR四种比值在结直肠癌患者预后诊断中的价值[J]. 中国免疫学杂志,2015,31(10):1389-1393.
[12] 黄金兰,郑诗豪,欧启水. 术前外周血NLR,dNLR及LMR在胶质母细胞瘤患者预后评估中的价值分析[J]. 福建医科大学学报,2017,51(6):404-409.
[13] 庄肃非,孟光冉,王恩龙,等. 中性粒细胞/淋巴细胞比值与结直肠癌临床病理特征的关系[J]. 宁夏医科大学学报,2015,37(10):1210-1212.
[14] Menges T,Engel J,Welters I,et al. Changes in blood lymphocyte populations after multiple trauma: association with posttraumatic complications[J]. Critical Care Medicine,1999,27(4):733-740.
[15] Gay L J,Feldinghabermann B. Contribution of platelets to tumour metastasis[J]. Nature Reviews Cancer,2011,11(2):123-134.
[16] 徐燕梅,崔天祥,张晓晶,等. 外周血单核细胞数量与肺癌放疗近,远期疗效的相关性分析[J]. 中华肺部疾病杂志(电子版),2014,7(2):29-33.
[17] Sabbagh C,Chatelain D,Trouillet N,et al. Does use of a metallic colon stent as a bridge to surgery modify the pathology data in patients with colonic obstruction? A case-matched study[J]. Surg Endosc,2013,27(10):3622-3631.