术前外周血NLR和PLR在结直肠癌预后评估中的价值
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摘要
目的:探讨术前外周血中性粒细胞计数与淋巴细胞计数比值(NLR)、血小板计数与淋巴细胞计数比值(PLR)对行结直肠癌根治术后患者预后的预测价值。方法:回顾性分析2007年至2012年就诊于湖南省常德市第一人民医院普外科行根治性手术且术后,随访资料完整的237例结直肠癌患者的临床资料。用ROC曲线确定NLR和PLR的Cut-off值后,分为高NLR/PLR组和低NLR/PLR组,比较两组患者的术后总体生存期。结果:NLR和PLR的Cut-off值分别是5. 26和169. 18;与低NLR水平患者相比较,高NLR水平患者的总体生存期明显低于低NLR水平患者(χ2=34. 252,P<0. 001);与低PLR水平患者相比较,高PLR水平患者的总体生存期明显低于低PLR水平患者(χ2=28. 698,P<0. 001); COX单因素回归分析或多因素回归分析均支持NLR (HR=5. 493,95%CI:2. 891～10. 437,P<0. 001; HR=3. 508,95%CI:1. 675～7. 345,P=0. 001)或PLR(HR=5. 094,95%CI:2. 624～9. 887,P<0. 001; HR=2. 092,95%CI:1. 006～4. 348,P=0. 048)可能是评判结直肠癌预后的独立风险因素。结论:NLR和PLR可用于评估结直肠癌患者的预后,NLR≥5. 26或PLR≥169. 18提示预后差。
Objective: To investigate the value of pre-operative neutrophil-to-lymphocyte ratio( NLR) and platelet-to-lymphocyte ratio( PLR) in the prognosis evaluation of colorectal cancer. Methods: The clinical data of 237 patients with colorectal cancer who were admitted to the First People' s Hospital of Changde City,Hunan Province from 2007 to 2012 were retrospectively analyzed. The ROC curves were used to determine the Cut-off values of NLR and PLR. The patients were divided into high NLR/PLR group and low NLR/PLR group. The overall survival was compared between the two groups. Results: The cut-off values of NLR and PLR were 5. 26 and 169. 18,respectively. The overall survival of patients with high NLR was significantly lower than that of patients with low NLR( χ2= 34. 252,P<0. 001),and the patients with high PLR had significantly lower overall survival than those with low PLR( χ2= 28. 698,P<0. 001). The results of COX univariate regression analysis or multivariate regression analysis supported that NLR( HR = 5. 493,95%CI: 2. 891-10. 437,P < 0. 001; HR = 3. 508,95% CI: 1. 675-7. 345,P = 0. 001) or PLR( HR = 5. 094,95% CI: 2. 624-9. 887,P <0. 001; HR = 2. 092,95% CI: 1. 006-4. 348,P = 0. 048) may be an independent risk factor for prognosis of colorectal cancer. Conclusion: NLR and PLR can be used to assess the prognosis of patients with colorectal cancer,NLR≥5. 26 or PLR≥169. 18 suggested a poor prognosis.
Objective: To investigate the value of pre-operative neutrophil-to-lymphocyte ratio( NLR) and platelet-to-lymphocyte ratio( PLR) in the prognosis evaluation of colorectal cancer. Methods: The clinical data of 237 patients with colorectal cancer who were admitted to the First People' s Hospital of Changde City,Hunan Province from 2007 to 2012 were retrospectively analyzed. The ROC curves were used to determine the Cut-off values of NLR and PLR. The patients were divided into high NLR/PLR group and low NLR/PLR group. The overall survival was compared between the two groups. Results: The cut-off values of NLR and PLR were 5. 26 and 169. 18,respectively. The overall survival of patients with high NLR was significantly lower than that of patients with low NLR( χ2= 34. 252,P<0. 001),and the patients with high PLR had significantly lower overall survival than those with low PLR( χ2= 28. 698,P<0. 001). The results of COX univariate regression analysis or multivariate regression analysis supported that NLR( HR = 5. 493,95%CI: 2. 891-10. 437,P < 0. 001; HR = 3. 508,95% CI: 1. 675-7. 345,P = 0. 001) or PLR( HR = 5. 094,95% CI: 2. 624-9. 887,P <0. 001; HR = 2. 092,95% CI: 1. 006-4. 348,P = 0. 048) may be an independent risk factor for prognosis of colorectal cancer. Conclusion: NLR and PLR can be used to assess the prognosis of patients with colorectal cancer,NLR≥5. 26 or PLR≥169. 18 suggested a poor prognosis.
引文
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[18]Xiao B,Chen D,Luo S,et al.Extracellular translationally controlled tumor protein promotes colorectal cancer invasion and metastasis through Cdc42/JNK/MMP9 signaling[J].Oncotarget,2016,7(31):50057-50073.
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[20]蒋峻梅,王祥德.结直肠癌患者血中可溶性P选择素、超敏C反应蛋白及血小板计数的分析[J].放射免疫学杂志,2013,26(1):74-75.Jiang JM,Wang XD.The analysis of soluble p-selectin,hs-CRPand platelet count in patient with colorectal cancer[J].J Radioimmunol,2013,26(1):74-75.
[21]Hattar K,Franz K,Ludwig M,et al.Interactions between neutrophils and non-small cell lung cancer cells:enhancement of tumor proliferation and inflammatory mediator synthesis[J].Cancer Immunol Immunother,2014,63(12):1297-1306.
[2]Torre LA,Siegel RL,Ward EM,et al.Global cancer incidence and mortality rates and trends--an update[J].Cancer Epidemiol Biomarkers Prev,2016,25(1):16-27.
[3]De Nardo DG,Johansson M,Coussens LM.Immune cells as mediators of solid tumor metastasis[J].Cancer Metastasis Rev,2008,27(1):11-18.
[4]彭维忠,杨浩洁,张克兰,等.外周血NLR或PLR与结直肠癌预后的相关性研究进展[J].中国免疫学杂志,2017,33(12):1902-1906.Peng WZ,Yang HJ,Zhang KL,et al.Progress in the correlation between NLR or PLR in peripheral blood and prognosis of colorectal cancer[J].Chin J Immunol,2017,33(12):1902-1906.
[5]Cho H,Hur HW,Kim SW,et al.Pre-treatment neutrophil to lymphocyte ratio is elevated in epithelial ovarian cancer and predicts survival after treatment[J].Cancer Immunol Immunother,2009,58(1):15-23.
[6]Tomita M,Shimizu T,Ayabe T,et al.Preoperative neutrophil to lymphocyte ratio as a prognostic predictor after curative resection for non-small cell lung cancer[J].Anticancer Res,2011,31(9):2995-2998.
[7]Dirican A,Kucukzeybek BB,Alacacioglu A,et al.Do the derived neutrophil to lymphocyte ratio and the neutrophil to lymphocyte ratio predict prognosis in breast cancer?[J].Int J Clin Oncol,2015,20(1):70-81.
[8]Kawahara T,Fukui S,Sakamaki K,et al.Neutrophil-to-lymphocyte ratio predicts prostatic carcinoma in men undergoing needle biopsy[J].Oncotarget,2015,6(31):32169-32176.
[9]Yang HJ,Guo Z,Yang YT,et al.Blood neutrophil-lymphocyte ratio predicts survival after hepatectomy for hepatocellular carcinoma:a propensity score-based analysis[J].World J Gastroenterol,2016,22(21):5088-5095.
[10]Mantovani A.Cancer:Inflaming metastasis[J].Nature,2009,457(7225):36-37.
[11]Witz IP.Yin-yang activities and vicious cycles in the tumor microenvironment[J].Cancer Res,2008,68(1):9-13.
[12]柳思琪,马俐君,颜宏利,等.RhoGDI2在结直肠癌中的表达及临床意义[J].中国免疫学杂志,2017,33(1):108-111.Liu SQ,Ma YJ,Yan HL,et al.Expression and clinical significance of Rho GDI2 in colorectal cancer[J].Chin J Immunol,2017,33(1):108-111.
[13]Guthrie GJ,Roxburgh CS,Farhan-Alanie OM,et al.Comparison of the prognostic value of longitudinal measurements of systemic inflammation in patients undergoing curative resection of colorectal cancer[J].Br J Cancer,2013,109(1):24-28.
[14]Roxburgh CS,Mc Millan DC.Role of systemic inflammatory response in predicting survival in patients with primary operable cancer[J].Future Oncol,2010,6(1):149-163.
[15]Rao HL,Chen JW,Li M,et al.Increased intratumoral neutrophil in colorectal carcinomas correlates closely with malignant phenotype and predicts patients'adverse prognosis[J].PLo S One,2012,7(1):e30806.
[16]张溪,胡柏来,吕震,等.肿瘤间质比及肿瘤浸润性淋巴细胞对晚期结直肠癌的预后价值[J].中国肿瘤临床,2015,42(4):241-246.Zhang X,Hu BL,LüZ,et al.The prognostic value of tumor stromal ratio and tumor infiltrating lymphocytes for advanced colorectal cancer[J].Chin J Clin Oncol,2015,42(4):241-246.
[17]Wang Y,Wang K,Han GC,et al.Neutrophil infiltration favors colitis-associated tumorigenesis by activating the interleukin-1(IL-1)/IL-6 axis[J].Mucosal Immunol,2014,7(5):1106-1115.
[18]Xiao B,Chen D,Luo S,et al.Extracellular translationally controlled tumor protein promotes colorectal cancer invasion and metastasis through Cdc42/JNK/MMP9 signaling[J].Oncotarget,2016,7(31):50057-50073.
[19]Ho AS,Chen CH,Cheng CC,et al.Neutrophil elastase as a diagnostic marker and therapeutic target in colorectal cancers[J].Oncotarget,2014,5(2):473-480.
[20]蒋峻梅,王祥德.结直肠癌患者血中可溶性P选择素、超敏C反应蛋白及血小板计数的分析[J].放射免疫学杂志,2013,26(1):74-75.Jiang JM,Wang XD.The analysis of soluble p-selectin,hs-CRPand platelet count in patient with colorectal cancer[J].J Radioimmunol,2013,26(1):74-75.
[21]Hattar K,Franz K,Ludwig M,et al.Interactions between neutrophils and non-small cell lung cancer cells:enhancement of tumor proliferation and inflammatory mediator synthesis[J].Cancer Immunol Immunother,2014,63(12):1297-1306.