中性粒细胞变化与结直肠癌患者预后的关系

Correlation between neutrophils changes and prognosis of colorectal cancer

目的探讨中性粒细胞变化对结直肠癌患者预后的预测价值。方法将结直肠癌患者体内的中性粒细胞分为外周血中性粒细胞和肿瘤相关中性粒细胞（tumor-associated neutrophils，TANs）两大类，外周血中性粒细胞用中性粒细胞／淋巴细胞比值（neutrophil to lymphocyte ratio，NLR）代替。分析两类中性粒细胞变化与结直肠癌患者临床病理因素及预后的关系。结果外周血NLR高和低的结直肠癌患者5年生存率分别为75．2％、88．2％；结直肠癌组织TANs高和低的结直肠癌患者5年生存率分别为97．6％、64．2％；外周血NLR低合并结直肠癌组织TANs高浸润、外周血NLR高合并结直肠癌组织TANs高浸润、外周血NLR低合并结直肠癌组织TANs低浸润、外周血NLR高合并结直肠癌组织TANs低浸润患者的5年生存率分别为100％、95．7％、76．4％、53．5％。两者联合后判断结直肠癌患者远期预后的能力明显优于单一项目评估。多因素分析显示，外周血高NLR、TANs低浸润、肿瘤位于直肠、TNM分期较晚是影响结直肠癌患者预后的独立危险因素（均P〈0．05）。结论术前外周血NLR联合结直肠癌组织中TANs可作为判断结直肠癌患者预后的重要指标，外周血高NLR合并结直肠癌组织TANs低浸润患者的复发风险较高。

Objective To investigate the prognostic value of neutrophil changes in patients with eolorectal cancer. Methods The neutrophils in patients with colorectal cancer were classified into two types： peripheral blood neutrophils and tumor-associated neutrophils （TANs）. Peripheral blood neutrophils are expressed as neutrophil/lymphocyte ratio （neutrephil to lymphocyte ratio, NLR ）. Results The 5 year＇s survival rates of patients with high and low NLR were 75.2% and 88.2%, respectively. The 5 year＇s survival rates of patients with high and low TANs were 97. 6% and 64. 2%, respectively. The survival rates of patients with low NLR and high TANs; high NLR and high infiltrating TANs; low NLR and low infiltrating TANs; and high NLR and low infiltrating TANs were respectively 100%, 95.7%, 76. 4% and 53.5%. With the two joining together the ability to distinguish long-term prognosis of patients was significantly better than any one alone. Multivariate regression analysis showed that, high peripheral blood NLR, low TANs infiltration, tumor located in the rectum, TNM staging are independent risk factors for colorectal cancer prognosis. Condusions NLR in preoperative peripheral blood combined with infiltrating TANs in colorectal cancer tissues can be used as a prognostic indicator for patients with colorectal cancer. High NLR in preoperative peripheral blood combined with low infiltrating TANs in colorectal cancer tissue predicts poor prognosis.