结直肠癌患者血小板与淋巴细胞比值对预后影响Meta分析

Prognostic value of platelet to lymphocyte ratio in patients with colorectal cancer:A Meta analysis

目的炎症反应在肿瘤的发生、发展中起到重要作用。血小板-淋巴细胞比值(platelet to lymphocyte ratio,PLR)作为反映机体系统性炎症的重要指标之一,是否可以预测结直肠癌患者预后尚有争议。本研究拟通过系统评价分析结直肠癌血中PLR与预后的关系,探讨PLR作为结直肠癌患者不良预后指标的可行性。方法使用计算机电子系统检索PubMed和Embase数据库至2015-05。纳入评价PLR与结直肠癌预后相关的队列或病例对照研究。使用风险比(hazard risk,HR)及95%可信区间(95%confidence interval,95%CI)作为研究的效应量,并进行发表偏倚、亚组分析和敏感性分析。应用Stata 12.0统计软件对资料进行Meta分析。结果共纳入13篇文献,包含4 190例患者。Meta分析结果显示,结直肠癌患者血中PLR高水平预示着不良的总生存率(overall survival,OS)(HR=1.394,95%CI为1.184~1.640,I2=38.2%)、无病生存率(disease-free survival,DFS)(HR=1.246,95%CI为1.090~1.425,I2=38.8%)和肿瘤无复发生存率(relapse-free survival,RFS)(HR=1.366,95%CI为1.081~1.727,I2=16.3%)。Begg’s和Egger’s检验均提示,研究间存在的发表偏倚差异无统计学意义;亚组分析显示,即使在亚洲组中PLR与OS、DFS未达到统计学意义,但仍具有很强的相关性,其他亚组结果均体现了结果的稳定性。结论结直肠癌患者血中PLR高水平提示患者具有更差的OS、DFS和RFS。PLR可作为结直肠癌患者不良预后的重要指标。

OBJECTIVE Whether platelet to lymphocyte ratio(PLR)can be used to predict the prognosis for colorectal cancer patients is controversial.The aim of our Meta analysis was to assess the relationship between PLR and prognosis of colorectal cancer patients.METHODS Pubmed and Embase database were systematically searched for the relevant studies assessing the relationship between PLR and prognosis of colorectal cancer(up to May 2015).Hazard ratio(HR)and 95% confidence intervals(95%CI)were used as effect measures in our Meta analysis.We performed publication bias and subgroup analysis.All the statistical analyses were conducted in the Stata 12.0software.RESULTS Our Meta analysis included 13 studies,containing 4 190 colorectal cancer patients.Our results showed that an elevated PLR was related to poor overall survival,disease-free survival and relapse-free survival in colorectal cancer patients(overall survival:HR=1.394,95%CI:1.184-1.640,I2=38.2%;disease-free survival:HR=1.246,95%CI:1.090-1.425,I2=38.8%;relapse-free survival:HR=1.366,95%CI:1.081-1.727,I2=16.3%).No obvious publication bias existed in our Meta analysis.The stability of our results was confirmed by subgroup analysis and sensitivity analysis.CONCLUSION Our Meta analysis shows that PLR is significantly related with the poor prognosis for colorectal cancer patients,and may act as an important prognostic factor.