血清ALB、NLR及AFR与早期结直肠癌患者NOSES术后预后的关系

Relationship between Serum ALB,NLR,AFR and Postoperative Prognosis of NOSES in Patients with Early Colorectal Cancer

目的:探讨血清白蛋白(ALB)、中性粒细胞与淋巴细胞比值(NLR)及白蛋白与纤维蛋白原比值(AFR)与早期结直肠癌患者经自然腔道取标本术(NOSES)术后预后的关系。方法:将2019年2月至2020年3月我院收治的76例早期结直肠癌患者纳入研究,比较不同临床特征患者ALB、NLR、AFR水平。根据术后随访情况将患者分为病情进展组和病情稳定组,比较2组患者血清ALB、NLR、AFR水平。以患者ALB、NLR、AFR水平平均值为临界值分为高水平组和低水平组,随访时间截至2024年2月,采用Kaplan-Meier法绘制生存曲线分析患者累积存活率。采用受试者工作曲线(ROC)分析ALB、NLR、AFR水平用于评估患者预后的价值。结果:截至最后随访日期,76例患者中23例患者出现复发或转移,复发率为30.26%;其中11例因肿瘤进展后死亡,死亡率为14.47%。无淋巴结转移,分化程度为中、高分化患者的ALB、AFR水平高于有淋巴结转移、分化程度为低分化患者;NLR水平低于有淋巴结转移、分化程度为低分化患者,差异有统计学意义(P<0.05)。病情稳定组患者ALB、AFR水平均高于病情进展组,NLR水平低于病情进展组,差异有统计学意义(P<0.05)。ALB高水平组患者累积存活率较低水平组患者高,差异有统计学意义(Logrankχ2=5.790,P=0.016);NLR高水平组患者累积存活率较低水平组患者低,差异有统计学意义(Logrankχ2=4.663,P=0.034);AFR高水平组患者累积存活率较低水平组患者高,差异有统计学意义(Logrankχ2=4.319,P=0.045)。绘制ALB、NLR、AFR预测结直肠癌患者NOSES术后预后的ROC曲线,结果显示其AUC分别为0.775、0.797、0.704,联合检测的AUC为0.853,准确度为87.3%,高于单一指标(P<0.05)。结论:早期结直肠癌患者NOSES术后预后情况和患者病情严重程度有关,血清ALB、NLR、AFR是患者预后的影响因素,联合检测对预测患者预后的准确度较高。

Objective To investigate the relationship between serum albumin(ALB),neutrophil to lym-phocyte ratio(NLR),albumin to fibrinogen ratio(AFR)and prognosis of patients with early colorectal cancer after natural orifice specimen extraction surgery(NOSES).Methods Total 76 patients with early colorectal cancer admitted to our hospital from February 2019 to March 2020 were included in the study,and the levels of ALB,NLR and AFR in patients with different clinical characteristics were compared.Ac-cording to the postoperative follow-up,the patients were divided into the progressive group and the stable group,and the serum levels of ALB,NLR and AFR were compared between the two groups.Patients were divided into the high level group and the low level group,taking the mean levels of ALB,NLR and AFR as the critical value.The follow-up period was up to February 2024.Kaplan Meier method was used to plot the survival curve to analyze the cumulative survival rate of patients.Receiver operating curve(ROC)was used to analyze the value of the levels of ALB,NLR and AFR in evaluating the prognosis.Results Up to the last follow-up date,recurrence or metastasis occurred in 23 of 76 patients,with a recurrence rate of 30.26%.Among them,11 cases died due to tumor progression,and the mortality rate was 14.47%.The levels of ALB and AFR in patients without lymph node metastasis and moderate to high differentiation were higher than those in patients with lymph node metastasis and low differentiation.The level of NLR in patients without lymph node metastasis and moderate to high differentiation was lower than that in pa-tients with lymph node metastasis and low differentiation,and the difference was statistically significant(P<0.05).The levels of ALB and AFR in the stable group were higher than those in the progressive group,and the level of NLR in the stable group was lower than that in the progressive group,with statis-tical significance(P<0.05).The cumulative survival rate in the high level group of ALB was higher than that in the low level group of ALB,and the difference was statistically significant(Logrankx2=5.790,P=0.016).The cumulative survival rate in patients of the high level group of NLR was lower than that in the low level group of NLR,and the difference was statistically significant(Logrankx2=4.663,P=0.034).The cumulative survival rate in patients of the high level group of AFR was higher than that in the low level group of AFR,and the difference was statistically significant(Logrankx2=4.319,P=0.045).ROC curves of ALB,NLR and AFR for predicting postoperative prognosis of patients with colorectal canc-er were plotted,and the results showed that the AUC of ALB,NLR and AFR were 0.775,0.797 and 0.704,respectively,and the AUC of combined detection was 0.853,with an accuracy of 87.3%,which was higher than that of single index(P<0.05).Conclusion The postoperative prognosis of NOSES in pa-tients with early colorectal cancer is related to the severity of the patients'disease.Serum ALB,NLR,and AFR are the influencing factors for prognosis,and the combined detection has high accuracy in predicting the prognosis of patients.