术前外周血中性粒细胞/淋巴细胞比值在结直肠癌预后评估中的价值

The value of preoperative peripheral blood neutrophil/lymphocyte ratio in the prognosis of colorectal cancer

[目的]探究中性粒细胞/淋巴细胞比值(neutrophil/lymphocyte ratio,NLR)与结直肠癌病因及预后相关性,为临床预测结直肠癌预后提供有效依据。[方法]回顾性分析2013年1月30日~2016年1月30日我院收治的120例可手术结直肠癌患者的临床病例资料,收集患者入院2 d血常规资料,计算NLR。对患者进行随访,随访截止时间为2019年3月30日,以全因死亡绘制ROC曲线,分析术前NLR对可手术结直肠癌患者死亡率预测价值。分析NLR与结直肠癌病因及预后相关性,并分析结直肠癌全因死亡的危险因素。[结果]失访患者10例,随访成功率91.7%。中位随访时间为55个月,死亡37例。ROC曲线显示,NLR预测死亡的最佳临界点为3.1,灵敏度为65.2%,特异度为74.4%。将3.1作为NLR临界值,NLR升高组(NLR>3.1)40例,NLR降低组(NLR≤3.1)70例。Logistic回归分析显示肿瘤部位(P=0.042,OR:1.325,95%CI:1.104~2.654)、TNM分期(P=0.032,OR:1.674,95%CI:1.233~5.987)是术前NLR的独立影响因素。Kaplan-Meier分析并Log-rank检验显示,NLR升高组生存率较NLR降低组显著降低,差异有统计学意义(P<0.05)。Cox比例风险模型多因素分析显示,术前NLR(P=0.035,OR:1.725,95%CI:1.124~6.674)、TNM分期(P=0.033,OR:1.835,95%CI:1.324~8.417)、年龄(P=0.045,OR:1.129,95%CI:1.054~2.215)、肿瘤分化程度(P=0.040,OR:1.378,95%CI:1.114~3.699)、脉管侵犯(P=0.041,OR:1.341,95%CI:1.097~3.241)是结直肠癌患者死亡率的独立预后因素(P<0.05)。[结论]术前NLR是结直肠癌死亡率的独立预后因素,可用于预测结直肠癌患者预后,NLR升高者预后不良。

[Objective] To investigate the correlation between neutrophil/lymphocyte ratio and etiology and prognosis of colorectal cancer,and to provide an effective basis for predicting the prognosis of colorectal cancer.[Methods]The clinical data of 120 patients with operable colorectal cancer admitted to our hospital from January 30,2013 to January 30,2016 were retrospectively analyzed.The blood routine data of patients admitted for 2 days were collected and NLR was calculated.The patients were followed up and the deadline for follow-up time was March 30,2019.The ROC curve was used to analyze the predictive value of preoperative NLR for mortality in patients with operable colorectal cancer.The relationship between NLR and etiology,and risk factors of all-cause mortality in colorectal cancer were analyzed.[Results]The effective rate of follow-up was 91.7%.The median follow-up time was 55 months.37 patients died.The ROC curve showed that the optimal threshold for NLR prediction of death was 3.1,the sensitivity was 65.2%,and the specificity was 74.4%.3.1 was used as the NLR threshold.There was 40 cases in the NLR-increased group(NLR>3.1),and 70 cases in the NLR-lowering group(NLR≤3.1).Logistic regression analysis showed that tumor sites(P=0.042,OR:1.325,95%CI:1.104-2.654),TNM staging(P=0.032,OR:1.674,95%CI:1.233-5.987)were independent effects of preoperative NLR.Kaplan-Meier analysis and Log-rank test showed that the survival rate of NLR-increased group was significantly lower than that of NLR-lowering group(P<0.05).Cox proportional hazard model multivariate analysis showed preoperative NLR(P=0.035,OR:1.725,95%CI:1.124-6.674),TNM staging(P=0.033,OR:1.835,95%CI:1.324-8.417),Age(P=0.045,OR:1.129,95%CI:1.054-2.215),degree of tumor differentiation(P=0.040,OR:1.378,95%CI:1.114-3.699),vascular invasion(P=0.041,OR:1.341,95%CI:1.097-3.241)were independent prognostic factors for mortality in colorectal cancer patients.[Conclusion]Preoperative NLR is an independent etiology for the prognosis of colorectal cancer.It can be used to predict the prognosis of patients with colorectal cancer.The prognosis of patients with elevated NLR is poor.