The Prognostic Value of Preoperative Peripheral Blood Inflammatory Markers Combined with Tumor Markers in Resectable Colon Cancer Patients
-
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。 
下载: 导出CSV
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。
下载: 导出CSV
-
[1] Sung H,Ferlay J,Siegel R L,et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin,2021,71(3):209-249. doi: 10.3322/caac.21660 [2] 王红,曹梦迪,刘成成,等. 中国人群结直肠癌疾病负担: 近年是否有变?[J]. 中华流行病学杂志,2020,41(10):1633-1642. doi: 10.3760/cma.j.cn112338-20200306-00273 [3] Mazaki J,Katsumata K,Sujino H,et al. Neutrophil-to-lymphocyte ratio as a prognostic factor for colon cancer in elderly patients: A Propensity Score Analysis[J]. Anticancer Res,2021,41(9):4471-4478. doi: 10.21873/anticanres.15256 [4] Iaciu C I,Emilescu R A,Cotan H T,et al. Systemic neutrophil-to-lymphocyte ratio as a prognostic biomarker for colon cancer[J]. Chirurgia (Bucur),2023,118(3):260-271. doi: 10.21614/chirurgia.2023.v.118.i.3.p.260 [5] Yamamoto T,Kawada K ,Obama K. Inflammation-related biomarkers for the prediction of prognosis in colorectal cancer patients[J]. Int J Mol Sci,2021,22(15):8002-8009. [6] Vural S,Muhtaroğlu A ,Uygur FA. The relationship between preoperative CEA and CA19-9 status and patient characteristics and lymph node involvement in early-stage colon cancer[J]. Eur Rev Med Pharmacol Sci,2023,27(10): 4563-4569. [7] Ramesh S K, Swain S K, Munikrishnan V, et al. Can the inflammatory cell ratio NLR and PLR be used as a reliable marker in colon cancer? A prospective study[J]. Euroasian J Hepatogastroenterol,2023,13(2):61-65. [8] Mizuno H, Miyake H, Nagai H, et al. Optimal cutoff value of preoperative CEA and CA19-9 for prognostic significance in patients with stage II/III colon cancer[J]. Langenbecks Arch Surg,2021,406(6):1987-1997. [9] Gupta R,Bhatt L K,Johnston T P,et al. Colon cancer stem cells: Potential target for the treatment of colorectal cancer[J]. Cancer Biol Ther,2019,20(8):1068-1082. doi: 10.1080/15384047.2019.1599660 [10] Khandia R ,Munjal A. Interplay between inflammation and cancer[J]. Adv Protein Chem Struct Biol,2020,119(0):199-245. [11] Zhong J,Zong S,Wang J,et al. Role of neutrophils on cancer cells and other immune cells in the tumor microenvironment[J]. Biochim Biophys Acta Mol Cell Res,2023,1870(7):119493. doi: 10.1016/j.bbamcr.2023.119493 [12] Wang S,Sun J,Chen K,et al. Perspectives of tumor-infiltrating lymphocyte treatment in solid tumors[J]. BMC Med,2021,19(1):140-147. doi: 10.1186/s12916-021-02006-4 [13] Masucci M T,Minopoli M,Carriero M V. Tumor associated neutrophils. Their role in tumorigenesis,metastasis,prognosis and therapy[J]. Front Oncol,2019,9(1):1146. [14] Farhood B,Najafi M ,Mortezaee K. CD8(+) cytotoxic T lymphocytes in cancer immunotherapy: A review[J]. J Cell Physiol,2019,234(6): 8509-8521. [15] Hou S, Jing J, Wang Y, et al. Evaluation of clinical diagnostic and prognostic value of preoperative serum carcinoembryonic antigen, CA19-9, and CA24-2 for colorectal cancer[J]. Altern Ther Health Med,2023,29(6):192-197. [16] 侯文运,吴斌,林国乐,等. 术前外周血白细胞相关炎性指标预测结肠癌预后价值分析[J]. 中国实用外科杂志,2021,41(4):433-437,442. [17] Sekiguchi M ,Matsuda T. Limited usefulness of serum carcinoembryonic antigen and carbohydrate antigen 19-9 levels for gastrointestinal and whole-body cancer screening[J]. Sci Rep,2020,10(1): 18202. [18] Guo L,Wang Q,Chen K,et al. Prognostic value of combination of inflammatory and tumor markers in resectable gastric cancer[J]. J Gastrointest Surg,2021,25(10):2470-2483. doi: 10.1007/s11605-021-04944-z [19] Wang R,Xu B,Sun M,et al. Dynamic monitoring of serum CEA and CA19-9 predicts the prognosis of postoperative stage II colon cancer[J]. Eur J Surg Oncol,2023,49(12):107138. -
点击查看大图
图(1) / 表(2)
计量
- 文章访问数: 284
- HTML全文浏览量: 492
- PDF下载量: 10
- 被引次数: 0
