淋巴细胞总数水平对直肠癌根治术后患者的临床意义及长期预后的影响

Effects of serum total lymphocyte number on clinicopathological features and overall survival outcome for cases with rectal cancer who received radical resection

目的本研究旨在探讨术前营养状态的指标之一,淋巴细胞总数水平,对接受根治手术的直肠癌患者的临床意义及其与预后的关系。方法 528例符合入组及排除标准的根治性直肠癌患者根据总淋巴细胞数目水平分为2组:低淋巴细胞总数组(淋巴细胞总数<1.7×109/L)及正常淋巴细胞总数组(淋巴细胞总数≥1.7×109/L)。分析2组患者的临床病理特点及生存预后差异。结果低淋巴细胞总数组的患者中老年患者多见,浸润型的比例亦显著高于正常组患者。低淋巴细胞总数组中,进展期的浸润深度分期、淋巴分期、远处转移分期、TNM分期以及Dukes分期比例明显高于对照组。低淋巴细胞组及正常组的患者5年生存率分别为30.3%及52.8%,差异具有显著的统计学意义。单因素及多因素回归分析结果均提示低淋巴细胞总数水平是独立预后不良因素之一。结论低淋巴细胞总数水平是营养不良的指标之一,其提示着较差的直肠癌临床病理特点及总体预后。但营养支持对营养不良但需接受根治手术的直肠癌患者长期预后的影响尚有待大规模的临床验证。

Objective We aimed to evaluate the clinical significance and long-term survivaloutcome of total lymphocyte number, one of the preoperative nutritional status markers, for cases with rectalcancer who received radical resection. Methods 528 cases with rectal cancer who received radical surgerywere divided into two groups according to the total lymphocyte number, there are low level lymphocytenumber group (total lymphocyte number < 1.7×109/L) and normal level lymphocyte number group (totallymphocyte number≥1.7×109/L). The differences of clinicopathological features and survival outcome werecompared between two groups. Results There were more senile patients and larger proportion of infiltrativetype in the low level lymphocyte number group. We found the cases in the low level lymphocyte numbergroup were more likely to be associated with advanced tumor depth stage, lymph node involvement, distantmetastasis, TNM classification, Dukes stage. The 5 year overall survival rates of patients in the low levellymphocyte number group and normal level lymphocyte number group was 30.3% and 52.8% respectivelyand the survival difference had statistical significance. The low level lymphocyte number was deemed asa poor independent prognosis by the univariate and multivariate regression analysis. Conclusions Thelow level lymphocyte number, one of the serum markers for malnutrition, were correlated with worseclinicopathological features and long-term prognosis. The effect of nutrition support for cases with rectalcancer who received radical resection still need further large-scale clinical verification.