术前NLR与合伴2型糖尿病的结直肠癌患者临床病理特征及预后相关性研究

The correlation between the preoperative NLR and clinicopathologic features and prognosis in colorectal cancer patients withtype 2 diabetes mellitus

[目的]以术后总生存时间(OS)为研究主要终点目标,探讨术前中性粒细胞/淋巴细胞比值(NLR)与合伴2型糖尿病(T2DM)的结直肠癌(CRC)患者的临床病理特征及预后相关性。[方法]收集178例合伴T2DM的CRC手术治疗患者临床资料和随访术后生存信息,根据预后分为存活组和死亡组,比较两组患者临床肿瘤病理特征差异性,COX回归模型分析预后影响因素,Spearman秩相关系数研判术前NLR与生存阳性因素的相关性。运用ROC曲线确定NLR截值,分为高NLR组和低NLR组,采用Kaplan-Meier法和Log-rank法进行生存分析。[结果](1)存活组与死亡组患者比较,术前NLR、年龄、肿瘤长径、浸润深度、淋巴结转移、远处转移、TNM分期、手术类型差异均具有统计学意义(P<0.05)。(2)COX回归分析表明术前NLR、肿瘤长径、浸润深度、淋巴结转移、远处转移、TNM分期、手术类型是合伴T2DM的CRC患者死亡的危险因素(P<0.05),其中术前NLR(HR=1.129,95%CI:1.051~1.213,P=0.001)、浸润深度(HR=3.402,95%CI:1.149~10.070,P=0.027)、淋巴结转移(HR=2.970,95%CI:1.237~7.134,P=0.015)、远处转移(HR=9.250,95%CI:4.308~19.863,P<0.001)系其独立危险因素。(3)Spearman秩相关系数分析提示术前NLR与浸润深度、淋巴结转移、TNM分期呈正相关(rs=0.336,0.233,0.318,P<0.05)。(4)术前NLR预测合伴T2DM的CRC患者死亡的曲线下面积(AUC)为0.738,最佳截点为2.53。(5)高NLR组与低NLR组相比,术后OS明显缩短(44.52±3.67)∶(69.50±2.13)个月,5年生存率更低(48.7%∶86.6%,χ^(2)=33.282,P<0.0001)。[结论]术前NLR与合伴T2DM的CRC患者的浸润深度、淋巴结转移、TNM分期呈正相关,高NLR组较低NLR组的OS明显缩短、5年生存率更低,为预后不良的重要预测因子及独立危险因素。

[Objective]To investigate the association between preoperative neutrophil to lymphocyte ratio(NLR)and clinicopathologic characteristics and prognosis in colorectal cancer(CRC)patients with type 2 diabetes mellitus(T2DM),with overall survival time(OS)of postoperative as the primary end point.[Methods]Clinical data and follow-up information of 178 CRC patients with T2DM who underwent surgery were collected.The patients were divided into survival group and death group to compare with clinicopathological characteristics between them.The COX regression model was employed to analyze the risk factors,and the Spearman rank correlation coefficient was applied to assess the association between the preoperative NLR and the prognosis factors.The cut-off value of NLR was determined using the receiver operating characteristic(ROC)curve,and then divided all patients into high NLR and low NLR groups.The survival analysis was performed by Kaplan-Meier method and Log-rank method.[Results](1)Significant differences were detected respectively in the preoperative NLR,age,tumor size,depth of invasion,lymph node metastasis,distant metastasis,TNM stage and surgical type when comparing the survival and death groups(P<0.05).(2)COX regression analysis indicated that preoperative NLR,tumor size,depth of invasion,lymph node metastasis,distant metastasis,TNM stage and surgical type were risk factors for mortality in CRC patients with T2DM(P<0.05),among which preoperative NLR(HR=1.129,95%CI:1.051-1.213,P=0.001),depth of invasion(HR=3.402,95%CI:1.149-10.070,P=0.027),lymph node metastasis(HR=2.970,95%CI:1.237-7.134,P=0.015)and distant metastasis(HR=9.250,95%CI:4.308-19.863,P<0.001)were independent risk factors.(3)Spearman Rank correlation coefficient analysis demonstrated that preoperative NLR was positively associated with invasion depth,lymph node metastasis,and TNM stage(r_s=0.336,0.233,0.318,P<0.05).(4)The area under the curves(AUC)of preoperative NLR for predicting the mortality of CRC patients with T2DM was 0.738 and the optimal cut-off value of NLR was 2.53.(5)The high NLR group had significantly worse postoperative OS(44.52±3.67)vs(69.50±2.13)months and lower 5-year survival(48.7%vs 86.6%,χ^(2)=33.282,P<0.0001).[Conclusion]Preoperative NLR was positively correlated with depth of invasion,lymph node metastasis and TNM stage in CRC patients with T2DM,and the high NLR group had significantly shorter OS and 5-year survival.Preoperative NLR was an important predictor and independent risk factor for poor prognosis.