NLR和PLR与结直肠癌患者TNM分期及预后的相关性研究

Correlation between neutrophil to lymphocyte ratio or platelet to lymphocyte ratio and TNM staging or prognosis in patients with colorectal cancer

目的确认术前中性粒细胞淋巴细胞比率(NLR)和血小板淋巴细胞比率(PLR)是否是结直肠癌患者的预后因素,并分析结直肠癌患者NLR和PLR与肿瘤TNM分期的关系。方法回顾性搜集四川大学华西医院同一医疗组2013年1月至2013年12月期间收治的符合纳入标准的304例结直肠癌患者的临床资料,分析NLR和PLR与结直肠癌患者临床病理特征的关系及其对预后的影响。结果以3年累积生存率为判断终点,NLR(灵敏度=51.0%,特异度=75.4%,受试者工作特征曲线下面积=0.66)与PLR(灵敏度=73.0%,特异度=46.4%,受试者工作特征曲线下面积=0.60)的临界值分别为2.27和155.92,然后根据NLR和PLR的临界值分为高低组,低NLR组(NLR≤2.27)有133例,高NLR组(NLR>2.27)有171例;低PLR组(PLR≤155.92)有207例,高PLR组(PLR>155.92)有97例。(1)3年累积生存率低NLR组为91.5%,高NLR组为77.2%,低NLR组患者的预后明显好于高NLR组患者(P=0.002);3年累积生存率低PLR组患者为89.0%,高PLR组患者为72.8%,低PLR组患者的预后也明显好于高PLR组患者(P=0.001)。(2)多因素分析结果显示,NLR是结直肠癌患者预后的独立危险因素(P=0.004),而PLR未能成为结直肠癌患者预后的独立危险因素(P=0.408)。(3)NLR和PLR均与TNM分期有关(分别为P=0.002,P=0.000);NLR在Ⅳ期时明显高于Ⅲ期(P=0.021)、Ⅱ期(P=0.002)及Ⅰ期(P=0.000),其他各期之间比较差异无统计学意义(P>0.05);PLR在Ⅳ期时明显高于Ⅲ期(P=0.022)、Ⅱ期(P=0.000)及Ⅰ期(P=0.000),在Ⅲ期明显高于Ⅱ期(P=0.040)和Ⅰ期(P=0.005),Ⅰ、Ⅱ期间比较差异并无统计学意义(P>0.05)。(4)NLR和PLR均与T分期相关(分别为P=0.006、P=0.031);NLR在T4期明显高于T2期(P=0.032)和T1期(P=0.015),其他各期之间比较差异无统计学意义(P>0.05);PLR在T4期明显高于T2期(P=0.013),其他各期之间比较差异无统计学意义(P>0.05)。(5)NLR与N分期无关(P=0.118);PLR与N分期有关(P=0.007),其在N1期和N2期结直肠癌患者中较N0期患者大幅度升高(分别为P=0.008、P=0.019)。(6)NLR和PLR在有远处转移的结直肠癌患者中较无远处转移者均明显升高(分别为P=0.004、P=0.001)。结论从本研究的初步研究结果来看,NLR是结直肠癌患者重要的独立预后指标,而当肿瘤有淋巴结转移时PLR则显著升高,血小板升高与淋巴结转移可能有一定的关系。

Objective To determine whether neutrophil to lymphocyte ratio （NLR） and platelet to lymphocyte ratio （PLR） are important prognostic factors in patients with colorectal cancerl and to clarify relationship between NLR or PLR and TNM staging in colorectal cancer. Methods The clinical data of 304 patients with colorectal cancer who were admitted to the same medical group from January 2013 to December 2013 in the West China Hospital of Sichuan University were analyzed retrospectively. The relationship between NLR or PLR and the dinicopathologic characteristics and its effects on prognosis of patients with colorectal cancer were analyzed. Results The critical values of NLR （sensitivity=51.0%, specificity=75.4%, area under the receiver operating characteristic curve=0.66） and PLR （sensitivity=73.0%, specificity=46.4%, area under the receiver operating characteristic curve=0.60） was 2.27 and 155.92, respectively, with a 3-year cumulative survival rate as the end point. According to the critical values of NLR and PLR, there were 133 cases in a low NLR group （NLR≤2.27）, 171 cases in a high NLR group （NLR〉2.27）, 207 cases in a low PLR group （PLR①〈 155.92）, 97 cases in a high PLR group （PLR〉 155.92）. ① The 3-year survival rate was 91.5% and 77.2% in the low NLR group and the high NLR group, respectively, which was 89.0% and 72.8% in the low PLR group and the high PLR group, respectively. The survival curves of NLR and PLR on prognosis prediction had significant differences （P=0.002, P=0.001）. ② The results of multivariate analysis showed that the NLR was the independent risk factor for colorectal cancer （P=0.004）, whereas PLR was not the independent risk factor for colorectal cancer （P=0.408）. （③ The NLR and PLR were associated with the tumor TNM staging （P=0.002, P=0.000）, which in the colorectal cancer with stage IV was significantly higher than those with stage -Ⅲ（P〈0.05）. ④ The NLR and PLR were associated with T stage （P=0.006, P=0.031）. The NLR in the colorectal cancer with stage T4 was significantly higher than that with stage Ⅰ（P-0.015） or stage Ⅱ （P=0.032）. The PLR in the colorectal cancer with stage T4 was significantly higher than that with stage Ⅱ （P=0.013）. ⑤ The NLR was not associated with N staging （P=0.118）. The PLR was associated with N staging （P=0.007）, which in the colorectal cancer with N2 stage was significantly higher than that with NO stage （P=0.008） or N1 stage （P=0.019）. ⑥ The NLR and PLR in the colorectal cancer with stage M1/M2 were significantly higher than those with stage M0 （P=0.004, P=0.001）. Conclusions Preliminary results of this study show that NLR is an important independent prognostic indicator for patient with colorectal cancer. While PLR is significantly increased when lymph node metastasis occurs, and platelet elevation might be related to lymph node metastasis.