术前血清CEA、CA199、dNLR与PLR联合检测对结直肠癌患者预后评估的价值

Value of Preoperative Combined Detection of Serum CEA,CA199,dNLR,and PLR in Evaluating Prognosis of Patients with Colorectal Cancer

目的探讨术前血清癌胚抗原(CEA)、糖类抗原199(CA199)、衍生的中性粒细胞与淋巴细胞比值(dNLR)与血小板与淋巴细胞比值(PLR)联合检测对结直肠癌患者预后评估的价值。方法选取2017年1月至2021年1月邢台市第三医院收治的86例结直肠癌患者为观察组,另选取同期36名健康体检者为对照组,比较两组研究对象的CEA、CA199、dNLR及PLR表达差异。进行术后1年门诊或电话随访,收集结直肠癌患者的基线资料,采用Logistic回归分析结直肠癌患者术后预后不良危险因素,采用受试者工作特征曲线(ROC曲线)探究CEA、CA199、dNLR、PLR单独与联合检测评估预后不良的价值。结果观察组的CEA、CA199水平和dNLR、PLR均显著高于对照组[(19.6±5.5)μg/L比(2.4±1.4)μg/L、(97±21)U/ml比(28±6)U/ml、2.8±1.6比1.5±1.0、150±30比90±31](P<0.01)。86例结直肠癌患者中,预后不良30例、预后良好56例。预后不良组的低分化、肿瘤TNM分期Ⅱ+Ⅲ期、肌层浸润比例及CEA、CA199水平和dNLR、PLR均明显高于预后良好组(P<0.05或P<0.01)。Logistic回归分析结果显示,低分化、存在肌层浸润、CEA、CA199水平和dNLR、PLR升高是结直肠癌术后预后不良的危险因素(P<0.05或P<0.01)。CEA、CA199、dNLR、PLR单独与联合预测结直肠癌患者术后预后不良ROC曲线下面积分别为0.724、0.737、0.778、0.708、0.811。结论结直肠癌患者术前血清CEA、CA199、dNLR、PLR联合检测可预测患者术后1年内复发转移情况,对临床评估患者预后具有指导意义。

Objective To explore the value of combined detection of preoperative serum carcinoembryonic antigen(CEA),carbohydrate antigen 199(CA199),derived neutrophil-to-lymphocyte ratio(dNLR),and platelet-to-lymphocyte ratio(PLR)in assessing the prognosis of patients with colorectal cancer.Methods A total of 86 patients with colorectal cancer admitted to Xingtai Third Hospital from Jan.2017 to Jan.2021 were included as an observation group,and 36 healthy individuals who underwent physical examinations during the same period were included as a control group.The differences in CEA,CA199,dNLR,and PLR expression between the two groups were compared.Outpatient or telephone follow-up were conducted one year after surgery,to collect baseline data of the patients,and Logistic regression analysis was used to identify risk factors for poor postoperative prognosis in the patients,and the value of CEA,CA199,dNLR,and PLR alone and in combination testing to evaluate poor prognosis were explored using receiver operating characteristic curve(ROC curve).Results The levels of CEA and CA199,dNLR and PLR in the observation group were significantly higher than those in the control group[(19.6±5.5)μg/L vs(2.4±1.4)μg/L,(97±21)U/ml vs(28±6)U/ml,2.8±1.6 vs 1.5±1.0,150±30 vs 90±31](P<0.01).Among the 86 patients with colorectal cancer,30 had poor prognosis and 56 had good prognosis.In the poor prognosis group,the proportion of low differentiation,tumor TNM stageⅡ+Ⅲ,myometrial infiltration,the levels of CEA,CA199,dNLR,PLR were higher than those in the good prognosis group(P<0.05 or P<0.01).The results of Logistic regression analysis showed that low differentiation,presence of muscle infiltration,CEA,CA199 levels,and elevated dNLR and PLR were risk factors for poor postoperative prognosis of colorectal cancer(P<0.05 or P<0.01).The area under ROC curve of CEA,CA199,dNLR and PLR for the prediction of poor postoperative prognosis of colorectal cancer were 0.724,0.737,0.778,0.708 and 0.811,respectively.Conclusion Combined detection of preoperative serum CEA,CA199,dNLR,and PLR can predict the occurrence of metastasis or recurrence in patients with colorectal cancer within one year after surgery,and has guiding significance for the clinical prognosis assessment.