摘要
目的探讨术前外周血中性粒细胞与淋巴细胞比值(NLR)与派生中性粒细胞与淋巴细胞比值(d-NLR)对评估结直肠癌(CRC)手术患者预后的价值。方法收集555例CRC根治性切除手术患者临床病理资料,并对其进行5年随访;利用ROC曲线确定NLR和d-NLR的cut-off值,Kaplan-Meier曲线和多重Cox回归分析NLR、d-NLR与CRC术后患者预后的关系,并构建临床预后预测列线图评价预测价值。结果以总生存期为判断终点,NLR(灵敏度=0.752,特异度=0.753,AUC=0.762)与d-NLR(灵敏度=0.721,特异度=0.683,AUC=0.720)的cut-off值分别为3.21和2.12;Kaplan-Meier曲线显示,术前NLR、d-NLR与CRC术后患者的无复发生存期和总生存期相关(P<0.01);多因素COX回归分析显示,NLR和d-NLR水平高是判断CRC术后患者无复发生存期(HRNLR=2.53,HRd-NLR=1.60)和总生存期(HRNLR=2.75,HRd-NLR=2.11)的独立预测因子;按包含与未包含NLR、d-NLR两因子分别构建无复发生存期和总生存期预测列线图,其C指数分别为0.851、0.836和0.801、0.793。结论术前NLR和d-NLR水平高则CRC术后患者无复发生存期和总生存期明显缩短;术前NLR和d-NLR可作为评估肿瘤II^III期CRC患者术后无复发生存期和总生存期的独立预后因子。
Objective To explore the prognostic value of preoperative neutrophil - to - lymphocyte ratio and derived neutrophil- to- lymphocyte ratio in colorectal cancer （CRC） individuals. Methods The clinical pathological data and preoperative blood routine test results were collected from medical records, and 5 year follow up was performed in a total of 555 surgically resected CRC cases. Receiver operative curve （ROC） was used to calculate NLR and d - NLR cut - off value, and Kaplan - Meier curve and multiple COX regression were selected to evaluate the influence of preoperative NLR and d- NLR on clinical outcome of CRC cases and prognostic predictive nomogram was established to evaluate the predictive value of NLR and d - NLR. Results Using overall survival （OS） as an endpoint, the optimal cut - off values of NLR and d - NLR were 3.21 （ Sensitivity = 0. 752, specificity = 0. 753, AUC = 0. 762） and 2.12 （ sensitivity = 0. 721, specificity = 0. 683, AUC = 0. 720） , respectively. Preoperative NLR and d - NLR were significantly associated with free - recurrent survival （RFS） and OS（P 〈 0.01 ）. NLR and d - NLR were independent factors for prediction of RFS （ HRNLR = 2.53, HRd_NLR = 1. 60） and OS （HRNLR = 2.75, HRd_NLR = 2. 11） in II - III stage preoperative CRC patients. The C - indexes of RFS and OS predictive nomograms including NLR and d - NLR were 0.851 and 0. 836, and C - indexes without NLR and d - NLR were 0. 801 and 0. 793 , respectively . Conclusion This results indicated that RFS and OS of the patients with preoperative high NLR and d - NLR were significantly shorter than those with relative low NLR and d - NLR, and they were independent prognostic predictive factors for RFS and OS, and nomograms including NLR and d - NLR could significantly improve the prognostic predictive efficacy in postoperative CRC individuals.
出处
《浙江预防医学》
2016年第4期362-367,共6页
Zhejiang Journal of Preventive Medicine
