The Prognostic Value of Preoperative Peripheral Blood Inflammatory Markers Combined with Tumor Markers in Resectable Colon Cancer Patients
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摘要:
目的 分析术前外周血相关炎性指标中性粒细胞/淋巴细胞比值（neutrophil to lymphocyte ratio，NLR）联合肿瘤标记物癌胚抗原（carcinoembryonic antigen，CEA）、糖蛋白抗原19-9 （glycoprotein antigen19-9，CA19-9）对结肠癌患者的预后价值。 方法 选取2018年5月至2020年10月在昆明医科大学第一附属医院就诊的158例结肠癌患者病例资料进行回顾性研究，受试者工作特征曲线（receiver operating characteristic curve，ROC）确定各项指标的临界值并进行分组，使用Kaplan-Meier法分析NLR、CEA、CA19-9及联合检测不同指标与患者生存预后的关系，通过多变量Cox回归分析影响患者预后因素。 结果 患者术前NLR水平（P = 0.035）、联合检测组（P = 0.008）及术后病理N分期（P < 0.001）为结肠癌患者的独立危险因素，且术前指标中联合检测组风险比最高（P = 0.008，HR= 2.664，95%CI 1.503～4.315）。 结论 术前外周血中NLR、CEA、CA19-9联合检测对结肠癌患者具有独立的预后价值。 -
关键词:
- 中性粒细胞/淋巴细胞比值 /
- 癌胚抗原（CEA） /
- 糖蛋白抗原（CA19-9） /
- 预后 /
- 结肠癌
Abstract:Objective To analyze the prognostic value of preoperative peripheral blood inflammatory markers neutrophil to lymphocyte ratio （NLR） combined with tumor markers carcinoembryonic antigen （CEA） and glycoprotein antigen CA19-9 in patients with colon cancer. Methods A retrospective study was conducted on 158 cases of colon cancer patients who visited the 1st Affiliated Hospital of Kunming Medical University from May 2018 to October 2020. The receiver operating characteristic curve （ROC） was used to determine the critical values of various indicators and group them. The Kaplan Meier method was used to analyze the relationship between NLR, CEA, CA19-9, and combined detection of different groups and patient survival prognosis. Multivariate Cox regression analysis was used to analyze the factors affecting patient prognosis. Results The preoperative NLR level （P = 0.035）, combined testing group （P = 0.008）, and postoperative pathological N stage （P < 0.001） were independent risk factors for OS, and the joint testing group had the highest risk ratio among preoperative indicators （P = 0.008, HR = 2.664, 95%CI 1.503～4.315）. Conclusion The combined detection of NLR, CEA, and CA19-9 in peripheral blood before surgery has independent prognostic value for patients with colon cancer. -
图 1 NLR、CEA、CA19-9ROC曲线及生存分析
A：NLR、CEA、CA19-9及联合检测ROC曲线；B：NLR组生存曲线；C：CEA组生存曲线；D：CA19-9组生存曲线；E：联合检测组生存曲线。
Figure 1. NLR，CEA，CA19-9ROC curves and survival analysis
表 1 结肠癌患者单因素分析
Table 1. Single factor analysis of colon cancer patients
类别 n 总生存 无病生存 生存率（%） P 生存率（%） P 性别 0.223 0.437 男 96 64.3 59.2 女 62 57.8 55.8 年龄（岁） 0.002* 0.083 ≤60 82 68.4 62.9 >60 76 53.8 45.5 肿瘤大小（cm） 0.001* 0.021* ≤4.5 73 66.4 60.7 >4.5 85 44.6 42.3 N分期 <0.001* <0.001* N0 93 70.4 68.6 N1 39 62.4 52.7 N2 26 40.2 37.3 T分期 0.329 0.089 T1-T2 26 60.7 53.4 T3-T4 132 48.3 44.6 分化程度 0.083 0.633 高分化 43 68.1 62.8 中分化 96 56.4 53.2 低分化 19 40.7 36.7 NLR 0.007* 0.015* <1.85 75 69.5 62.2 ≥1.85 83 51.3 46.1 CEA（ng/ml） 0.023* 0.010* <5 93 59.8 53.2 ≥5 65 40.8 38.1 CA19-9（U/ml） 0.035* 0.266 <28.3 78 62.8 56.4 ≥28.3 80 56.3 47.2 NLR+CEA+CA19-9 0.008* 0.008* 阴性组 23 69.6 62.6 阳性组 135 37.0 33.3 注：*P < 0.05。 
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表 2 结肠癌患者多因素分析
Table 2. Multivariate analysis of colon cancer patients
因素 总生存 无病生存 HR值（95%CI） P HR值（95%CI） P 年龄 1.004（0.529～1.904） 0.271 1.200（0.743～1.939） 0.456 肿瘤大小 1.454（0.837～2.194） 0.106 0.801（0.411～1.563） 0.515 N分期 2.804（1.373-5.724） <0.001* 2.514（1.627～3.882） <0.001* NLR 1.577（1.074～2.283） 0.035* 1.678（1.084～1.598） 0.021* CEA 1.088（0.871～1.493） 0.353 1.442（0.940～2.211） 0.094 CA19-9 0.860（0.774～1.249） 0.761 1.287（0.828～2.000） 0.262 NLR+CEA+CA19-9 2.664（1.503～4.315） 0.008* 1.927（1.211～2.908） 0.009* 注：*P < 0.05。
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