中性粒细胞与淋巴细胞比值联合检测纤维蛋白原对结直肠癌预后的判断价值

Combined fibrinogen concentration and neutrophil-lymphocyte ratio as a prognostic marker of colorectal cancer

目的:探讨中性粒细胞与淋巴细胞比值(NLR)和纤维蛋白原(Fibrinogen,FIB)联合形成指标FIB-NLR在结直肠癌预后中的临床意义。方法:回顾性分析我院2010年6月至2011年6月接受手术治疗的250例结直肠癌患者的临床资料,分别分析NLR和FIB与结直肠癌的病理特征的关系,将NLR与FIB进行联合形成一个指标(FIB-NLR)。将250名结直肠癌患者分为3组,患者NLR≥2.95及FIB≥348 mg/dl定为FIB-NLR 2分组,NLR≥2.95及FIB<348 mg/dl或者NLR<2.95及FIB≥348 mg/dl定为1分组,NLR<2.95及FIB<348 mg/dl为0分组,并分析3组患者在结直肠癌的浸润深度、分期、淋巴结转移、神经浸润、远处转移、组织学分级中是否具有差异性。并将3组患者按生存时间做生存分析,并对3组患者的生存率进行比较。结果:中晚期及有淋巴结转移结直肠癌患者NLR值明显高于分期较早及无淋巴结转移患者的NLR,差异具有统计学意义(P<0.001),肿瘤浸润深度较深、有神经浸润、有远处转移的患者其NLR值明显高于浸润深度较浅、无神经浸润、无远处转移患者的NLR值,差异具有统计学意义(P=0.006、P=0.002、P=0.007)。中晚期、有淋巴结转移、有远处转移的结直肠癌患者其FIB值明显高于早期及无淋巴结转移、无远处转移的结直肠癌患者的FIB值,差异具有统计学意义(P<0.001),浸润深度越深及有神经浸润的结直肠癌患者FIB值明显高于浸润深度浅及无神经浸润患者的FIB值,差异具有统计学意义(P=0.015、P=0.012)。NLR与FIB均在肿瘤的组织学分级、年龄大小、性别肿瘤部位无明显关联(P>0.05)。结直肠癌的临床分期越晚、浸润深度越深、有淋巴结转移、有远处转移、有神经浸润的患者其FIB-NLR评分较早期、浸润深度浅、无淋巴结转移及无远处转移、无神经浸润患者高,差异具有统计学意义(P<0.001)。生存分析发现,评分越高组其5年生存率越低,差异具有统计学意义(P=0.001)。结论:FIB-NLR可能是一个潜在的判断结直肠癌进展及预后的有效指标。

Objective：To explore the significance of combined fibrinogen concentration and neutrophil-lymphocyte ratio as a prognostic marker of colorectal cancer. Methods： A retrospective analysis of the hospital in June 2010-June 2011 of received and accepted the surgical treatment of colorectal cancer patients, respectively analysis the relationship NLR and FIB with the pathological characteristics of colorectal cancer,neutrophils and lymphocytes ratio （NLR） and the concentration of fibrinogen （FIB） were combined to form a index （FIB-NLR）. 250 patients with colorectal cancer recording the scores were divided into three groups, patients NLR acuity 2. 95 and FIB 〉348 mg/dl as FIB-NLR 2 groups,NLR acuity 2. 95 and FIB 〈 348 mg/dl or NLR 〈 2. 95 and FIB acuity 348 mg/dl for 1 group, NLR 〈 2. 95 and FIB 〈 348 mg/dl of 0 group, and analyzed three groups with invasion depth, clinical staging and lymph node metastasis of colorectal cancer, nerve invasion, distant metastasis and histological grades. And the three groups respectively for survival analysis, and carried on the comparison to the survival rates of three groups. Results ： Moderate and advanced and with lymph node metastasis of colorectal cancer patients was significantly higher than the earlier stage and no lymph node metastasis in patients with NLR, statistically significant difference （P〈0. 001 ） ;tumor infiltration depth deeper, nerve invasion and distant metastasis of the NLR value was significantly higher in patients with infiltrating depth shallow, without nerve invasion and distant metastasis in patients with NLR values, the difference was statistically significant （ P = 0. 006, P = 0. 002, P = O. 007 ）. Moderate and advanced stage, lymph node metastasis and distant metastasis of colorectal cancer patients with the FIB values were significantly higher than the early and without lymph node metastasis and distant metastasis of eoloreetal cancer patients FIB values, the difference was statistically significant （P〈 0. 001 ） , the deeper the infiltration depth and colorectal cancer patients with neural infiltrates FIB values significantly higher than the in- filtration and shallow depth, of FIB values for patients with nerve infiltration,the difference was statistically significant （P= O. 015 ,P= O. 012 ）. NLR and FIB in tumor histologic stage ,age ,gender ,tumor location ,had no significant association （P〉O. 05 ）. The patients withlater clinical stage of colorectal cancer, the deeper the infiltration depth, lymph node metastasis, distant metastasis had a high FIB-NLR score than infiltration and shallow depth, without lymph node metastasis and distant metastasis, no nerve infiltration patients was high, the difference was statistically significant （P〈0. 001 ）. Survival analysis found that the higher the score of patients the 5-year survival rate was lower, the difference had statistical significance （ P = O. 001 ）. Conclusion： Neutrophil-lymphocytes ratio （NLR） and fibrinogen （FIB） joint form a index FIB-NLR may be a potential progression effective index which estimate the progression of colorectal cancer.