术前炎症相关标记物对结直肠癌根治术后预后影响的研究

Association of pre-operative inflammatory biomarkers with colorectal cancer after radical surgery

目的评价炎症相关标记物及评分对结直肠癌术后预后包括局部复发和（或）远处转移以及5年无病生存率（DFS）的影响。方法纳入成都大学附属医院2000年1月至2012年12月术前未行放化疗并接受根治性切除术且相关资料齐全的进展期结直肠癌患者（Ⅱ、Ⅲ期）332例,回顾性分析术前中性粒细胞/淋巴细胞（NLR）、纤维蛋白原、C-反应蛋白（CRP）、白蛋白以及改良格拉斯哥预后评分（mGPS）与进展期结直肠癌患者术后远期预后的关系。统计采用SPSS 19.0进行χ~2检验、均值t检验,远期生存采用Kaplan-Meier生存分析。结果本研究共纳入332例患者,5年内共计73例（22.0%）局部复发,87例（26.2%）远处转移,复发和（或）转移150例（45.2%）,同时性或异时性复发转移患者10例（3.0%）。NLR〈5.0组及≥5.0组局部复发率分别为16.9%和35.6%（P〈0.001）,远处转移率分别为19.1%和45.6%（P〈0.001）,5年DFS率分别为65.7%和25.6%（P〈0.001）。纤维蛋白原〈325 mg/dl组及≥325 mg/dl组局部复发率分别为23.0%和19.6%,远处转移率分别为21.7%和36.3%（P=0.005）,5年DFS率分别为65.2%和31.4%（P〈0.001）。m GPS 0、1、2组局部复发率分别为11.6%、23.2%和30.3%（P=0.001）,远处转移率分别为15.9%、36.6%和53.0%（P〈0.001）,5年DFS率分别为71.0%、50.0%和34.8%（P〈0.001）。结论 NLR、纤维蛋白原及m GPS均可有效预测结直肠癌术后复发和转移风险,但该结论尚需进一步研究证实。

Objective To evaluate the effects of biomarkers including inflammatory-related and the modified Glasgow prognostic score （mGPS） on local recurrence （LR） and distant metastasis （DM） and 5-year disease free survival （DFS） in patients with colorectal cancer （CRC） after radical surgery. Methods 332 patients with CRC （stage Ⅱ or Ⅲ） after radical surgery without neoadjuvant therapy （NT） were retrospectively analyzed. The biomarkers included neutrophil-to-lymphocyte ratio （NLR）, fibrinogen, （FB）, C-reactive protein （CRP）, albumin （ALB）. SPSS 19 was used for chi square test, and mean t test. The long-term survival was analyzed by Kaplan-Meier survival analysis. Results 332 patients were included in this study. In 5 years, 73 patients （22.0%） had local recurrence, 87 patients （26.2%） had distant metastasis, 150 cases （45.2%） suffered LR and/or DM, 10 cases （3.0%） had LR and DM. LR rate of NLR〈5.0 group and greater in the NLR group rate respectively 16.9% and 35.6% （P〈0.001）, DM rate was 19.1% and 45.6% （P〈0.001） and 5 year DFS rate 65.7% and 25.6% （P〈0.001）. LR rate of FB〈325 mg/dl group and over 325 mg/dl was 23.0% and 19.6%, DM rate was 21.7% and 36.3% （P=0.005）, 5 year DFS rate were 65.2% and 31.4% （P〈0.001）. LR rate of MGPS 0, 1, and 2 groups were 11.6%, 23.2% and 30.3% （P=0.001）, DM rate was 15.9%, 36.6% and 53.0% （P〈0.001）, the 5 year DFS rate was 71.0%, 50.0% and 34.8% （P〈0.001）, respectively. Conclusion NLR, FB and mGPS can effectively predict the risk of recurrence and metastasis after colorectal cancer surgery, but the conclusion needs to be confirmed in further study.