术前NLR对同时性结直肠癌肝转移患者的预后价值

The prognostic value of preoperative neutrophil-lymphocyte ratio in patients with concurrent colorectal cancer and liver metastasis

目的 探讨术前中性粒细胞/淋巴细胞比值(NLR)和癌胚抗原(CEA)对同时性结直肠癌肝转移患者的预后价值。方法 回顾性收集2012年8月至2017年12月期间在河北北方学院附属第一医院行同期肝切除的同时性结直肠癌肝转移患者的临床病理资料,使用X-TILE软件来计算NLR的最佳截止点;采用Kaplan-Meier生存曲线和Log-rank检验来绘制和比较生存曲线,利用Cox比例风险回归模型来分析独立预后因素;采用时间依赖性曲线下面积(t-AUC)来绘制和比较不同指标联合使用时的预后价值。结果 共有122例同时性结直肠癌肝转移患者被纳入此研究,NLR进行预后分层时的最佳截止点为2.1,术前较高的NLR和更高的病理T分期相关(P=0.037),但与低NLR组相比在其他指标上均无明显差异(P>0.05);单因素生存分析提示术前NLR水平、最大肝转移直径、结直肠癌p T分期、是否淋巴结转移和术前CEA水平与同时性结直肠癌肝转移患者的预后相关(P均<0.05);多因素生存分析肝转移数目(HR=1.644,95%CI=1.063~2.542,P=0.025)、有淋巴结转移(HR=1.76,95%CI=1.045~2.965,P=0.034)、CEA≥3.4μg/L(HR=1.611,95%CI=1.054~2.460,P=0.028),以及NLR≥2.1(HR=1.625,95%CI=1.044~2.539,P=0.033)是同时性结直肠癌肝转移患者预后的独立危险因素。NLR在预测患者预后时的t-AUC为60.89%~66.41%,CEA为58.15%~66.41%,联合检测时的t-AUC为64.53%~68.36%,CEA在预测患者预后时的C-index为0.648(95%CI=0.543~0.752),NLR为0.688(95%CI=0.583~0.795),二者相比无明显差异(P=0.29),联合检测时C-index可提高到0.69(95%CI=0.586~0.795),但对比单独使用CEA(P=0.12)或NLR(P=0.52)时均无统计学差异。结论 术前NLR或CEA升高与同时性结直肠癌肝转移患者的不良预后密切相关,联合应用术前NLR和CEA可提高对患者预后预测的准确性。

Objective To investigate the prognostic value of preoperative neutrophil-to-lymphocyte ratio( NLR) and carcinoembryonic antigen( CEA) in patients with concurrent colorectal cancer liver metastases. Method The clinicopathological data of patients with concurrent colorectal cancer liver metastases who underwent liver resection in our hospital from August 2012 to December 2017 were retrospectively analyzed, and X-TILE software was used to calculate the best cut-off value of NLR. Kaplan-Meier method and Log-rank test were used to draw and compare different survival curves, and COX proportional hazards regression model was used to analyze independent prognostic factors. The time dependent area under ROC curve( t-AUC) is used to draw and compare the prognostic value of different indicators, also in combination. Result A total of 122 patients with concurrent liver metastases from colorectal cancer were included in this study. After calculation, the best cut-off value for NLR for prognostic stratification is 2. 1. The preoperative higher NLR was correlated with higher pathological T staging(P= 0. 037), but compared with the low NLR group, there was no significant difference in other indicators( all P> 0. 05). Univariate survival analysis showed that preoperative NLR level,maximum liver metastasis diameter, colorectal cancer p T stage, lymph node metastasis and preoperative CEA level were correlated with the prognosis of patients with concurrent colorectal cancer liver metastasis( all P<0. 05);multivariate Survival analysis: the number of liver metastases(HR= 1. 644, 95%CI= 1. 063-2. 542, P= 0. 025), lymph node metastases(HR= 1. 76, 95%CI= 1. 045-2. 965, P =0. 034), CEA≥3. 4 μg/L(HR= 1. 611, 95%CI= 1. 054-2. 460, P= 0. 028) and NLR≥2. 1(HR= 1. 625, 95%CI= 1. 044-2. 539,P= 0. 033) are the prognosis of patients with liver metastases from concurrent colorectal cancer Independent risk factors. When NLR predicts patient prognosis, t-AUC is 60. 89% ~66. 41%, CEA is 58. 15%-66. 41%, and t-AUC is 64. 53%-68. 36% when the two indicates are combined. In addition, the C-index of CEA in predicting the prognosis of patients was 0. 648(95%CI= 0. 543-0. 752),and the NLR was 0. 688(95%CI= 0. 583-0. 795). There was no significant difference between the two indicates(P = 0. 29). When combination CEA and NLR to predict the prognosis, the C-index could be increased to 0. 69( 95%CI= 0. 586-0. 795). However,there was no statistical difference when compared with CEA(P = 0. 12) or NLR(P = 0. 52) alone, respectively. Conclusion The elevate of preoperative NLR or CEA is closely related to the poor prognosis of patients with concurrent colorectal cancer liver metastases. The combined use of preoperative NLR and CEA can improve the accuracy of predicting the prognosis of patients.