比较各炎性反应预后评分系统对结直肠癌根治术后患者的预后价值

Comparison of prognostic value of preoperative inflammation-based scores and TNM stage in patients with colorectal cancer

目的比较格拉斯哥评分(Glasgow prognostic score,GPS)、中性粒细胞/淋巴细胞比值(neutrophil/lymphocyte ratio,NLR)、血小板/淋巴细胞比值(platelet/lymphocyte ratio,PLR)、预后营养指数(prognostic nutritional index,PNI)和预后指标(prognostic index,PI)炎性反应预后评分系统及TNM分期对结直肠癌根治术后患者的预后价值。方法回顾性分析274例行根治术后的结直肠癌患者。根据术前检查结果计算GPS、NLR、PLR、PNI和PI评分。采用单因素、多因素分析及生存曲线分析其与患者预后的关系。采用线性趋势χ^2检验、似然比χ^2检验和受试者工作特征(receiver operating characteristic,ROC)曲线比较不同预后评分系统及TNM分期的预后价值。结果单因素分析显示,结直肠癌患者的术后总体生存时间及无瘤生存时间在术前体质量减轻、C反应蛋白(C-reactive protein,CRP)及白蛋白水平、肿瘤分化程度、是否行辅助化疗、GPS评分、PLR、NLR、PI、PNI和术后TNM分期方面比较,差异均具有统计学意义(均P<0.05)。多因素分析显示,TNM分期、是否行辅助化疗、GPS评分、NLR、PLR、PI和PNI为结直肠癌患者的独立预后因素(均P<0.05)。GPS较其他以炎性反应为基础的预后评分系统(NLR、PLR、PI和PNI)具有更高的似然比χ^2值、线性趋势χ^2值和ROC曲线下面积,并且与TNM分期相近。结论 GPS为结直肠癌患者术后的独立预后因素,其预后价值与TNM分期相近,优于NLR、PLR、PI和PNI预后评分系统。

Objective To compare the prognostic value of inflammation-based prognostic scores [Glasgow prognostic score(GPS), neutrophil/lymphocyte ratio(NLR), platelet/lymphocyte ratio(PLR), prognostic nutritional index(PNI) and prognostic index(PI)] and tumor node metastasis(TNM) stage in patients undergoing resection of colorectal cancer. Methods The inflammation-based prognostic scores were calculated for 274 patients with colorectal cancer after radical resection. The scores of GPS, NLR, PLR, PNI and PI were calculated according to the results of preoperative blood sampling. The prognostic significance was analyzed by univariate and multivariate analyses. Linear trend χ^2 test, likelihood ratio χ^2 test and receiver operating characteristic(ROC) curve were performed to compare the prognostic value of the selected scores and TNM stage. Results In univariate analysis, preoperative weight loss, serum C-reactive protein, serum albumin, GPS, PLR, NLR, PI, PNI, differentiation, adjuvant chemocherapy and TNM stage were significantly associated with overall survival and progression free survival(all P<0.05). In multivariate analysis, GPS, NLR, PLR, PI, PNI, PI, adjuvant chemocherapy and TNM stage were independent prognostic predictors(all P<0.05). GPS had higher linear trend χ^2 value, likelihood ratio χ^2 value and larger area under the ROC curve, compared to other inflammation-based prognostic scores. Conclusions GPS is an independent prognostic factor for patients with colorectal caner. The prognostic value of preoperative GPS is similar to that of TNM, and is superior to NLR, PLR, PI and PNI prognostic scoring system.