术前中性粒细胞与淋巴细胞比值联合癌胚抗原检测对直肠癌患者预后的评估价值

Predictive value of preoperative neutrophil-to-lymphocyte ratio combined with carcinoembryonic antigen in prognosis of patients with rectal cancer

目的探讨术前中性粒细胞与淋巴细胞比值(NLR)联合癌胚抗原(CEA)对直肠癌预后的评估价值。方法选取268例直肠癌患者,依据术后5年生存情况,分为生存组和死亡组,比较两组患者的临床特征,影响直肠癌患者预后的独立影响因素采用Cox回归分析,采用受试者工作特征(ROC)曲线和曲线下面积(AUC)评估NLR及CEA单独及联合检测对直肠癌预后的评估价值。结果随访结束,268例直肠癌患者中,生存156例,病死112例,直肠癌患者术后5年生存率为58.21%。将生存患者和病死患者分别作为生存组和死亡组,生存组和死亡组直肠癌患者性别、年龄比较,差异均无统计学意义(P﹥0.05);生存组和死亡组直肠癌患者TNM分期、分化程度、肿瘤直径、神经侵犯情况、浸润深度、远处转移情况、淋巴结转移情况、CEA水平及NLR比较,差异均有统计学意义(P﹤0.05)。Cox回归分析结果显示,TNM分期、肿瘤直径、远处转移、CEA水平和NLR是直肠癌患者预后不良的独立危险因素(P﹤0.05)。CEA、NLR及二者联合预测直肠癌预后的AUC分别为0.991、0.923、0.997,CEA和NLR联合检测对直肠癌患者的预后评估具有较高的准确性,二者联合检测的AUC高于单独预测的AUC(P﹤0.05)。结论术前NLR联合CEA检测对直肠癌预后具有较高的预估价值,二者联合能够为评估直肠患者预后提供重要的参考信息。

Objective To explore the predictive value of preoperative neutrophil-to-lymphocyte ratio(NLR)combined with carcinoembryonic antigen(CEA)in the prognosis of rectal cancer patients.Method A total of 268 patients with rectal cancer were analyzed retrospectively.According to whether the patients survived 5 years after operation,they were divided into survivors group and death group.The general clinical data of the two groups were compared.Cox regression analysis was used to analyze the independent factors affecting the prognosis of rectal cancer patients.The prognostic value of NLR or CEA alone or in combination for rectal cancer were evaluated by receiver operating characteristic(ROC)curves and its area under the curve(AUC).Result At the end of follow-up,of the 268 cases of rectal cancer,156 cases survived while 112 cases dead,resulting in the 5-year survival rate being 58.21%.Between survivors and death groups,no statistical differences were observed for gender and age(P>0.05);while there were significant differences in regard to TNM stage,degree of differentiation,tumor size,perineural invasion,depth of tumor invasion,distant metastasis,lymph node metastasis,CEA levels and NLR between the two groups(P<0.05).Cox regression analysis showed that TNM stage,tumor size,distant metastasis,CEA and NLR were independent risk factors for poor prognosis in patients with rectal cancer.The AUC of CEA,NLR and their combination in predicting the prognosis of rectal cancer were 0.991,0.923 and 0.997,respectively,with the highest accuracy for prognostic evaluation observed for CEA combined with NLR,besides,the AUC of the combined detection was significantly higher than the AUC of each used alone(P<0.05).Conclusion Preoperative NLR combined with CEA detection is of highly predictive value,the combined detection provides important information for evaluating the prognosis of patients with rectal cancer.