应用术前外周血NLR,dNLR,PLR及LMR预测梗阻性左半结肠癌患者预后

Preoperative Peripheral Blood NLR, dNLR, PLR and LMR in Prediction of Long-Term Survival for Obstructive Left-Side Colorectal Cancer

目的探讨术前外周血中中性粒细胞/淋巴细胞比值(NLR)、间接中性粒细胞/淋巴细胞比值(dNLR)、血小板/淋巴细胞比值(PLR)、淋巴细胞/单核细胞比值(LMR)与急诊手术组(ES组)和肠道金属支架置入后择期手术组(SEMS组)的梗阻性左半结肠癌患者预后的关系,评估其对预后的预测价值。方法回顾性分析88例梗阻性左半结肠癌患者的临床病理资料和随访资料,采用Kaplan-Meier生存分析ES组和SEMS组3年无瘤生存率的差别,比较2组患者术前不同时期外周血中NLR,dNLR,PLR和LMR的比值,通过受试者工作特征曲线(ROC曲线)确定NLR,dNLR,PLR和LMR预测3年无瘤生存率的最佳分界点及预测效能,并根据此节点将患者分为高比值组和低比值组。采用Kaplan-Meier生存分析,单因素及多因素Cox回归进一步分析影响2组梗阻性左半结肠癌患者预后的独立危险因素。结果 SEMS组和ES组3年无瘤生存时间分别为(28.40±1.91),(27.82±1.88)月,差别无统计学意义(P>0.05)。SEMS组支架置入前患者外周血中NLR,PLR平均值明显高于SEMS组(P=0.046,P=0.042)。ES组术前患者外周血中NLR平均值明显高于SEMS组(P=0.015)。ES组术前外周血中NLR和dNLR能有效预测术后3年无瘤生存率,ROC曲线下面积(AUC)分别为0.570和0.632;其中NLR的最佳分界点为19.57,dNLR的最佳分界点为1.58。ES组的CEA表达量(P=0.044)、肿瘤大小(P=0.013)和术前外周血NLR比值是影响术后3年无瘤生存率的危险因素。多因素分析发现,术前外周血中NLR≥19.57是影响ES患者术后3年无瘤生存率的独立危险因素(HR=7.412,95%CI=1.874～29.314)。SEMS组患者的肿瘤浸润深度是影响预后的独立危险因素(P=0.002,HR=10.837,95%CI=2.377～49.401)。结论术前外周血中NLR是影响ES梗阻性左半结肠癌患者预后的独立危险因素,而肿瘤浸润深度是影响SEMS梗阻性左半结肠癌患者预后的独立危险因素。

Objective To explore the role and efficacy of preoperative neutrophil-lymphocyte ratio(NLR),derived neutrophil-lymphocyte ratio(dNLR),platelet-lymphocyte ratio(PLR)and lymphocyte-monocyte ratio(LMR)in prediction of disease-free survival for obstructive left-side colorectal cancer patients who receive emergency surgery(ES)or self-expandable metal stent(SEMS)insertion followed with elective surgery.Methods The clinicopathological data and follow-up data of 88 patients with obstructive left colon cancer were analyzed retrospectively.The difference in the 3-year disease free survival rate between ES and SEMS was analyzed by Kaplan-Meier survival.The ratio of NLR,dNLR,PLR and LMR in the peripheral blood were compared between ES and SEMS group,and the optimal cut-off point was confirmed by receiver operating characteristic curve(ROC curve).Finally,the patients were divided into high ratio group and low ratio group according to the optimal cut-off point.Kaplan-Meier survival analysis,single factor and multiple factor Cox regression were used to further analyze the independent risk factors affecting the prognosis of ES and SEMS group with obstructive left-side colorectal cancer.Results The 3-year disease-free survival time of SEMS group was(28.40±1.91)months,while the 3-year disease-free survival time of ES group was(27.82±1.88)months(P >0.05).The mean values of NLR and PLR in the SEMS group before implantation were significantly higher than they were before surgery(P=0.046,P=0.042).The mean value of NLR in the ES group was significantly higher than that of SEMS group before surgery(P=0.015).The NLR and dNLR in peripheral blood of ES group could effectively predict the 3-year disease free survival(3-year DFS),the area under the ROC curve(AUC)were 0.570 and 0.632,respectively.The optimal cut-off point of NLR was 19.57,and optimal cut-off point of dNLR was 1.58.PLR and LMR in peripheral blood of SEMS group before stent insertion could also predict the 3-year DFS rate,while the AUC were 0.526 and 0.711,respectively,of which the optimal cut-off point of PLR was 190.10,and the optimal cut-off point of LMR was 1.34.The CEA expression level(P=0.044),tumor size(P=0.013)and peripheral blood NLR ratio in ES patients were the risk factors for the 3-year DFS.Multi-variate Cox regression analysis showed that NLR≥19.57 in peripheral blood before operation was an independent risk factor(HR=7.412,95%CI=1.874~29.314)that affected the 3-year DFS in ES group.The depth of tumor invasion is an independent risk factor(P=0.002,HR=10.837,95%CI=2.377~49.401)that significantly affected the prognosis of SEMS group.Conclusion[WTBZ]NLR in peripheral blood is an independent risk factor for the prognosis of patients with obstructive left-side colorectal cancer in ES group.However,only the depth of tumor invasion significantly affects the prognosis of patients with obstructive left-side colorectal cancer in SEMS group.