免疫炎症联合肝脏功能血液学指标对结直肠癌转移的预测价值

Predictive Value of Immune Inflammation Combined with Liver Function Hematological Indicators for Metastasis of Colorectal Cancer

目的探讨免疫炎症联合肝脏功能血液学指标对结直肠癌转移的预测价值。方法回顾性分析133例结直肠癌患者临床资料,根据术后随访24个月的疾病进展情况,将其分为无转移组(n=38)、肝转移组(n=43)和非肝远处转移组(n=52),分析无进展生存期的免疫炎症指标和肝脏功能血液学指标,单因素和多因素Logistic回归分析结直肠癌发生转移的风险因素,构建列线图预测模型。采用受试者工作特征曲线(ROC)和校准曲线验证列线图的准确度,通过决策曲线和临床影响曲线评价列线图的临床预测效能。结果单因素及多因素Logistic回归分析显示泛免疫炎症值(PIV)、预后营养指数(PNI)与胆汁酸(BA)是结直肠癌发生转移的独立预测因素,三者联合预测转移的ROC曲线下面积为0.84;中性粒细胞/淋巴细胞比值(NLR)和BA是结直肠癌发生肝转移的独立预测因素,二者联合预测肝转移的ROC曲线下面积为0.83;PIV和PNI是结直肠癌发生非肝远处转移的独立预测因素,二者联合预测非肝远处转移的ROC曲线下面积为0.83;校准曲线、决策曲线和临床影响曲线显示该三种模型具有良好的准确度及净效益值。结论基于免疫炎症和肝脏功能血液学指标构建的列线图可预测结直肠癌患者的转移情况,具有较高的预测效能及临床应用前景。

Objective To explore the predictive value of immune inflammation combined with liver function hematological indicators for the metastasis of colorectal cancer.Methods A retrospective analysis of clinical data of 133 patients with colorectal cancer was conducted.The patients were divided into three groups based on disease progression after 24 months of postoperative follow-up:non-metastasis group(n=38),liver metastasis group(n=43),and non-liver distant metastasis group(n=52).The immune inflammatory markers and liver function hematological indicators of progression-free survival were analyzed.Nomogram prediction models were constructed using univariate and multivariate logistic regression analyses to identify risk factors for metastasis of colorectal cancer.The accuracy of the nomogram was validated using receiver operating characteristic(ROC)curve and calibration curve,and the clinical predictive efficacy was evaluated through decision curve and clinical impact curve.Results Univariate and multivariate logistic regression analyses showed that pan-immune-inflammatory value(PIV),prognostic nutritional index(PNI),and bile acid(BA)were independent predictors of colorectal cancer metastasis.The area under the ROC curve of the combined prediction of metastasis was 0.84;neutrophil/lymphocyte ratio(NLR)and BA were independent predictors of liver metastasis from colorectal cancer.The area under the ROC curve of the combined prediction of liver metastasis was 0.83;PIV and PNI were independent predictive factors for the occurrence of non-liver distant metastasis from colorectal cancer.The area under the ROC curve for the combined prediction of non-liver distant metastasis was 0.83.The calibration curve,decision curve,and clinical impact curve showed that the three models had good accuracy and net benefit value.Conclusion The nomogram constructed based on immune inflammation and liver function hematological indicators can predict the metastasis of patients with colorectal cancer and has high predictive efficacy and clinical application prospects.