全身免疫炎症评分与结直肠癌临床病理特征的相关性分析

Relationship between systematic immune-inflammation index and clinicopathological charac-teristics for colorectal cancer

目的探讨全身免疫炎症评分(SII)与结直肠癌临床病理特征的相关性。方法采用回顾性队列研究方法。收集2019年2月至2021年5月首都医科大学附属北京友谊医院收治的513例结直肠癌病人的临床病理资料;男311例,女202例;年龄为(64±12)岁。观察指标:(1)结直肠癌病人SII情况及其与临床病理特征的相关性分析。(2)结直肠癌病人SII的影响因素分析。以SII中位数为截断值,将病人分为高SII和低SII病人进行分析。正态分布的计量资料以x±s表示,组间比较采用t检验。计数资料以绝对数或百分比表示,组间比较采用χ^(2)检验。偏态分布的计量资料以M(P25,P75)表示,组间比较采用非参数秩和检验。等级资料比较采用Mann-Whitney U非参数检验。选取组间比较差异有统计学意义的变量进一步分析。其中计量资料采用Pearson相关系数分析,等级资料采用Wilcoxon或Kruskal-Willas分析并进行Bonferroni校正。采用线性回归进行单因素和多因素分析。结果(1)结直肠癌病人SII情况及其与临床病理特征的相关性分析:513例病人的SII为355(253,507)。513例病人以SII中位数355为截断值,257例SII>355为高SII,256例SII≤355为低SII。高SII病人Karnofsky功能状态(KPS)评分,术前白蛋白(Alb),CA125,肿瘤位置(左半结肠、右半结肠),肿瘤长径、手术方式(腹腔镜辅助、开腹),病理学T分期(T0期、T1期、T2期、T3期、T4期),病理学TNM分期(Ⅰ、Ⅱ、Ⅲ、Ⅳ期)分别为(87±17)分,(37±5)g/L,8.80 U/mL(5.90 U/mL,14.15 U/mL),174、83例,(5.2±2.8)cm,208、44例,5、19、25、131、63例,34、98、94、14例;低SII病人上述指标分别为(91±13)分,(38±4)g/L,7.20 U/mL(5.40 U/mL,10.03 U/mL),200、56例,(4.0±1.9)cm,221、24例,8、39、35、118、45例,61、84、79、12例,两者上述指标比较,差异均有统计学意义(t=-2.770、-3.211,Z=-3.799,χ^(2)=7.050,t=5.324,χ^(2)=6.179,Z=-3.390、-2.227,P<0.05)。Pearson相关系数分析结果显示:SII与肿瘤长径呈正相关(r=0.390,P<0.05)、与术前Alb呈负相关(r=-0.200,P<0.05)。Wilcoxon分析结果显示:肿瘤位于右半结肠与左半结肠、行开腹手术与腹腔镜辅助手术病人SII分别为447(311,720)与352(251,493)、439(284,640)与345(243,481);肿瘤位于右半结肠与左半结肠病人,行开腹手术与腹腔镜辅助手术病人SII比较,差异均有统计学意义(P<0.05)。Kruskal-Willas分析结果显示:病理学T分期(T0、T1、T2、T3、T4期),病理学TNM分期(Ⅰ、Ⅱ、Ⅲ、Ⅳ期)病人SII分别为289(201,463)、296(210,398)、329(252,446)、369(265,505)、434(274,631),307(226,400)、380(260,503)、381(272,563)、376(273,634);不同病理学T分期病人、不同病理学TNM分期病人SII比较,差异均有统计学意义(P<0.05)。(2)结直肠癌病人SII的影响因素分析。单因素分析结果显示:KPS评分、术前Alb、CA125、肿瘤位置、肿瘤长径、病理学N分期、病理学TNM分期是影响结直肠癌病人SII的相关因素(Beta值=-3.5,-15.8,3.7,106.3,51.8,115.1,104.7,141.2,95%可信区间为-5.7~-1.3,-22.6~-9.1,1.8~5.5,34.6~177.9,38.5~65.2,40.5~189.7,11.2~198.2、46.9~235.9,P<0.05)。多因素分析结果显示:肿瘤位置、肿瘤长径是结直肠癌病人SII的独立影响因素(Beta值=79.5,42.5,95%可信区间为8.4~150.7,26.6~58.4,P<0.05)。结论结直肠癌病人SII与肿瘤位置、肿瘤长径、术前Alb、病理学T分期、病理学TNM分期具有相关性。术前低蛋白血症提示高SII,肿瘤长径越长、肿瘤位于右半结肠、TNM分期越高、机体免疫炎症失衡状态更为严重。肿瘤位置和肿瘤长径是结直肠癌SII的独立影响因素。

Objective To investigate the relationship between systematic immune-inflamma-tion index(SII)and clinicopathological characteristics for colorectal cancer.Methods The retrospec-tive cohort study was conducted.The clinicopathological data of 513 patients with colorectal cancer who were admitted to the Beijing Friendship Hospital of Capital Medical University from February 2019 to May 2021 were collected.There were 311 males and 202 females,aged(64±12)years.Observation indicators:(1)SII of colorectal cancer and relationship between SII and clinicopatholo-gical characteristics;(2)influencing factors for SII in colorectal cancer patients.According to the median of SII as the cutoff value,the patients were divided into high SII and low SII patients.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was analyzed using the t test.Count data were represented as absolute numbers or percen-tages,and comparison between groups was conducted using the chi-square test.Measurement data with skewed distribution were represented as M(P25,P75),and comparison between groups was analyzed using the non-parameter rank sum test.Comparison of ordinal data was analyzed using the Mann-Whitney U non-parameter test.Variables with statistically significant differences between groups were included for further analysis.Pearson correlation coefficient analysis was used for continuous data,and Wilcoxon or Kruskal-Willas analysis was used for categorical data and Bonferroni correction was performed.Univariate and multivariate linear regression analyses were conducted.Results(1)SII of colorectal cancer and relationship between SII and clinicopathological charac-teristics:the SII of 513 patients was 355(253,507).Taking the median SII 355 as the cutoff value,257 of 513 patients with SII>355 had high SII and 256 cases with SII≤355 had low SII.Of high SII patients,the Karnofsky performance status(KPS)score,preoperative albumin(Alb),CA125,cases with tumor located at left or right hemicolon,tumor diameter,cases with laparoscopic assisted surgery or laparotomy(surgical approach),cases in stage T0,T1,T2,T3,T4(pathological T staging),cases in stageⅠ,Ⅱ,Ⅲ,Ⅳ(pathological TNM staging)were 87±17,(37±5)g/L,8.80 U/mL(5.90 U/mL,14.15 U/mL),174,83,(5.2±2.8)cm,208,44,5,19,25,131,63,34,98,94,14.The above indicators of low SII patients were 91±13,(38±4)g/L,7.20 U/mL(5.40 U/mL,10.03 U/mL),200,56,(4.0±1.9)cm,221,24,8,39,35,118,45,61,84,79,12.There were significant differences in above indicators between the two groups(t=-2.770,-3.211,Z=-3.799,χ^(2)=7.050,t=5.324,χ^(2)=6.179,Z=-3.390,-2.227,P<0.05).Results of Pearson correlation coefficient analysis showed that SII was positively correlated with the tumor diameter(r=0.390,P<0.05),and negatively correlated with preoperative Alb(r=-0.200,P<0.05).Results of Wilcoxon analysis showed that SII was 447(311,720),352(251,493)in patients with tumor located at right hemicolon and left hemicolon,439(284,640),345(243,481)in patients undergoing laparotomy and laparoscopic assisted surgery,respectively.There were signi-ficant differences in SII between patients with tumor located at right and left hemicolon,between patients undergoing laparotomy and laparoscopic assisted surgery(P<0.05).Results of Kruskal-Willas analy-sis showed that SII was 289(201,463),296(210,398),329(252,446),369(265,505),434(274,631)in patients with pathological T staging as stage T0,stage T1,stage T2,stage T3,stage T4,respectively,and 307(226,400),380(260,503),381(272,563),376(273,634)in patients with patho-logical TNM staging as stageⅠ,stageⅡ,stageⅢ,stageⅣ,respectively.There were significant differences in SII between patients with different pathological T staging and between patients with different pathological TNM staging(P<0.05).(2)Influencing factors for SII in colorectal cancer patients:results of univariate analysis showed that KPS score,preoperative Alb,CA125,tumor location,tumor diameter,patholo-gical N staging,pathological TNM staging were related factors for SII in colorectal cancer patients(Beta=-3.5,-15.8,3.7,106.3,51.8,115.1,104.7,141.2,95%confidence interval as-5.7 to-1.3,-22.6 to-9.1,1.8 to 5.5,34.6 to 177.9,38.5 to 65.2,40.5 to 189.7,11.2 to 198.2,46.9 to 235.9,P<0.05).Multivariate analysis showed that tumor location and tumor diameter were independent influencing factors for SII in colorectal cancer patients(Beta=79.5,42.5,95%confidence interval as 8.4 to 150.7,26.6 to 58.4,P<0.05).Conclusions The SII is correlated with tumor location,tumor diameter,preoperative Alb,pathological T staging,pathological TNM staging.Preoperative hypoproteinemia indicates a high SII score.The longer of tumor diameter,right hemicolon tumor and high TNM staging indicate the more serious immune-inflammatory imbalance.Tumor location and tumor diameter are independent influencing factors for SII in colorectal cancer patients.