摘要
目的分析术前外周血白细胞相关炎性指标对非转移性结肠癌病人预后的预测价值。方法回顾性分析2016年1月至2017年9月北京协和医院基本外科结直肠专业组收治的554例行结肠癌根治术病人的临床病理资料。Kaplan-Meier法分析白细胞(WBC)计数、中性粒细胞百分比(NE%)和中性粒细胞与淋巴细胞比值(NLR)与病人生存预后的关系;通过多因素COX回归分析影响病人预后的因素。结果WBC、NLR和NE%的最佳截断值分别为8.25×10^(9)/L、2.27和59.0%。单因素分析显示,病人术前癌胚抗原(CEA)、NE%和NLR值和术后病理N分期与总生存(OS)、无病生存(DFS)均有相关性;病人年龄、术前WBC仅与OS具有相关性。多因素分析显示,病人术后病理N分期(HR=2.634,95%CI 1.441~4.814,P=0.002)和NLR(HR=1.098,95%CI 1.028~1.173,P=0.005)是OS的独立危险因素;术后病理N分期(HR=2.512,95%CI 1.627~3.880,P<0.001)和NLR(HR=1.101,95%CI 1.037~1.169,P=0.002)是DFS的独立危险因素;病人年龄≥65岁是OS(HR=1.042,95%CI 1.013~1.072,P=0.005)的独立危险因素。结论虽然术前外周血NLR升高的非转移性结肠癌病人预后较差,但NLR值对病人预后ROC曲线区分度较低,故不建议将术前外周血白细胞相关炎性指标作为非转移性结肠癌预后的标记物。
Objective To analyze the prognostic values of preoperative white blood cell(WBC)related inflammatory markers in the patients with non-metastatic colon cancer.Methods The clinicopathological data of the patients underwent radical colectomy at Peking Union Medical College Hospital from January 2016 to September 2017 were analyzed retrospectively.The association of WBC count,NE% and NLR with patients’prognosis was analyzed by Kaplan-Meier.Multivariate Cox regression analysis was performed to analyze the prognostic factors.Results The optimal cut-off values of WBC count,NLR and NE% were 8.25×10^(9)/L,2.27 and 59%.The univariate analysis demonstrated that N-stage,carcinoembryonic antigen(CEA)level,NE% and NLR were significantly associated with overall survival(OS)and disease-free survival(DFS).However age and WBC were only significantly associated with OS.Multivariate analysis showed lymph node metastasis(HR=2.634,95%CI 1.441-4.814,P=0.002)and NLR(HR=1.098,95%CI 1.028-1.173,P=0.005)were independent risk factors of overall survival(OS).Lymph node metastasis(HR=2.512,95%CI 1.627-3.880,P<0.001)and NLR(HR=1.101,95%CI 1.037-1.169,P=0.002)were independent risk factors of disease free survival(DFS).Age≥65(HR=1.042,95%CI 1.013-1.072,P=0.005)was independent risk factor of OS.Conclusion The prognosis of the non-metastatic patients in high NLR group is worse.However,the ROC curve of NLR was poor.Therefore,preoperative WBC related inflammatory indicators should not recommended as predictive markers of prognosis in non-metastatic colon cancer patients.
作者
侯文运
吴斌
林国乐
邱辉忠
孙曦羽
周皎琳
牛备战
陆君阳
徐徕
张冠南
肖毅
HOU Wen-yun;WU Bin;LIN Guo-le;XIAO Yi(Department of General Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China)
出处
《中国实用外科杂志》
CAS
CSCD
北大核心
2021年第4期433-437,442,共6页
Chinese Journal of Practical Surgery
基金
中国医学科学院中央级公益性科研院所基本科研业务费临床与转化医学研究基金(No.2019XK32003)。
关键词
结肠癌
白细胞
中性粒淋巴细胞比值
炎症
预后
colon cancer
white blood cell
neutrophil-to-lymphocyte ratio
inflammatory
prognosis
