术前中性粒细胞淋巴细胞比、血小板淋巴细胞比和炎症营养指数对结直肠癌根治术患者预后的预测价值

Values of Preoperative NLR,PLR and INI in the Prognosis of Colorectal Cancer Patients Undergoing Radical Gastrectomy

目的:探讨术前外周血中性粒细胞与淋巴细胞比值(neutrophil-to-lymphocyte ratio, NLR)、血小板与淋巴细胞比值(platelet-to-lymphocyte ratio, PLR)和炎症营养指数(inflammatory-nutritional index, INI)对结直肠癌根治术患者预后的预测价值。方法:采用回顾性队列研究方法,收集我院2014年1月至2016年12月期间行结直肠癌根治术的202例患者的临床病理资料,计算NLR、PLR和INI,采用ROC曲线确定最佳截断值,并将患者分为高、低比值组,采用多因素Cox比例风险回归模型确定各指标对预后的影响。结果:术前低NLR组患者的总生存期明显高于高NLR组患者,差异有统计学意义(χ^(2)=24.121,P<0.001);术前低PLR组患者的总生存期明显高于高PLR组患者,差异有统计学意义(χ^(2)=18.947,P<0.001);术前高INI组患者的OS明显高于低INI组患者,差异有统计学意义(χ^(2)=16.524,P<0.001)。单因素分析显示,肿瘤大小、淋巴结转移、癌结节、肿瘤分化程度、远处转移、T分期、TNM分期、术前NLR、PLR和INI与结直肠癌患者术后总生存期相关(均P<0.05);多因素Cox比例风险回归分析显示:癌结节、T分期、TNM分期、术前NLR、PLR和INI水平是影响结直肠癌患者术后预后的独立危险因素(均P<0.05)。结论:术前高NLR、PLR和低INI水平与结直肠癌患者术后总体生存期密切相关,是其预后的独立影响因素。

Objective: To explore the prognostic values of preoperative neutrophil-to-lymphocyte ratio(NLR), platelet-to-lymphocyte ratio(PLR) and inflammatory-nutritional index(INI) in the prognosis of colorectal cancer patients undergoing radical gastrectomy. Methods: A retrospective cohort study was conducted to collect the clinicopathological data of 202 colorectal cancer patients who underwent radical resection in our hospital from January 2014 to December 2016. NLR, PLR and INI values were calculated. The cut-off value was determined by ROC curve. And the patients were assigned to high-and low-ratio groups. The multivariate Cox proportional hazards regression model was used to determine the influence of each index on prognosis. Results: Before surgery, OS in the low NLR group was significantly higher than that in the high NLR group before surgery(χ^(2)=24.121, P<0.001);OS in the low PLR group was significantly higher than that in the high PLR group(χ^(2)=18.947, P<0.001);OS in the high INI group was significantly higher than that in the low INI group(χ^(2)=16.524, P<0.001). Univariate analysis showed that tumor size, lymph node metastasis, tumor deposits, degree of differentiation, distant metastasis, T stage, TNM stage, preoperative NLR, preoperative PLR and preoperative INI were correlated to postoperative overall survival(all P<0.05);multivariate Cox proportional hazards regression analysis showed that tumor deposits, T stage, TNM stage, preoperative NLR, preoperative PLR and preoperative INI were independent risk factors of postoperative prognosis of colorectal cancer patients(all P<0.05). Conclusion: Preoperative high NLR, PLR and low INI levels are closely correlated to the overall survival of colorectal cancer patients, and are independent factors influencing the prognosis.