Abstract：ObjectiveTo explore the prognostic value of preoperative neutrophil-to-lymphocyte ratio and derived neutrophil-to-lymphocyte ratio in colorectal cancer (CRC) individuals. MethodsThe 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. ResultsUsing 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. ConclusionThis 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.
崔莹珊, 陈小林, 周航亮, 张瑞光. 术前外周血NLR和d-NLR水平与结直肠癌手术患者预后的相关性研究[J]. 预防医学, 2016, 28(4): 362-367.
CUI Ying-shan, CHEN Xiao-lin, ZHOU Hang-liang, ZHANG Rui-guang. A study on the association between preoperative NLR and d-NLR and clinical outcome of postoperative colorectal cancer patient. Preventive Medicine, 2016, 28(4): 362-367.
[1] CANDIDO J, HAGEMANN T. Cancer-related inflammation[J]. J Clin Immunol,2013, 33(Suppl 1): S79-84. [2] GO S I, LEE A, LEE U S, et al. Clinical significance of the neutrophil-lymphocyte ratio in venous thromboembolism patients with lung cancer[J]. Lung Cancer,2014, 84(1): 79-85. [3] KILINCALP S, COBAN S, AKINCI H, et al. Neutrophil/[CM)]lymphocyte ratio, platelet/lymphocyte ratio, and mean platelet volume as potential biomarkers for early detection and monitoring of colorectal adenocarcinoma[J]. Eur J Cancer Prev,2015,24(4): 328-333. [4] DIRICAN A, KUCUKZEYBEK B B, ALACACIOGLU A, et al. Do the derived neutrophil to lymphocyte ratio and the neutrophil to lymphocyte ratio predict prognosis in breast cancer?[J]. Int J Clin Oncol,2015, 20(1):70-81. [5] MALIETZIS G, GIACOMETTI M, ASKARI A, et al. Apreoperative neutrophil to lymphocyte ratio of 3 predicts disease-free survival after curative elective colorectal cancer surgery[J]. Ann Surg, 2014, 260(2):287-292. [6] SZKANDERA J, GERGER A, LIEGL-ATZWANGER B, et al. The lymphocyte/monocyte ratio predicts poor clinical outcome and improves the predictive accuracy in patients with soft tissue sarcomas[J]. Int J Cancer,2014, 135(2):362-370. [7] ULICH T R, DEL CASTILLO J, KEYS M, et al. Kinetics and mechanisms of recombinant human interleukin 1 and tumor necrosisfactor-alpha- induced changes in circulating numbers of neutrophils and lymphocytes[J]. J Immunol,1987, 139(10): 3406-3415. [8] 丁燕, 南娟, 刘谦. 慢性炎症、肿瘤微环境与癌变[J].中国肺癌杂志,2009, 12(9): 1022-1030. [9] GRAZIOSI L, MARINO E, DE ANGELIS V, et al. Prognostic value of preoperative neutrophils to lymphocytes ratio in patients resected for gastric cancer[J]. Am J Surg,2015, 209(2) :333-337. [10] CEDRÉS S, TORREJON D, MARTÍNEZ A,et al. Neutrophil to lymphocyte ratio (NLR) as an indicator of poor prognosis in stage IV non-small cell lung cancer[J]. Clin Transl Oncol,2012, 14(11): 864-869. [11] GAO F, LI X, GENG M, et al. Pretreatment neutrophil-[CM)]lymphocyte ratio: an independent predictor of survival in patients with hepatocellular carcinoma[J].Medicine (Baltimore),2015, 94(11):e639. [12] AZAB B, MOHAMMAD F, SHAH N, et al. The value of the pretreatment neutrophil lymphocyte ratio vs. platelet lymphocyte ratio in predicting the long-term survival in colorectal cancer[J]. Cancer Biomark,2014, 14(5):303-312. [13] WEITZMAN S A, GORDON L I. Inflammation and cancer: role of phagocyte-generated oxidants in carcinogenesis[J]. Blood,1990,76(4): 655-663. [14] 朱元民,刘玉兰. 感染、炎症与肿瘤的发生[J]. 胃肠病学和肝病学杂志,2013,22(2): 105-108. [15] 王从玉,邓跃华,刘弋,等. nm23 VE6F-C及VEGFR-3在大肠癌中的表达及意义[J]. 中国肿瘤临床,2008,35(9): 1117-1121. [16] KIM S L, LEE S T, TRANG K T, et al. Parthenolide exerts inhibitory effects on angiogenesis through the down regulation of VEGF/VEGFRs in colorectal cancer[J]. Int J Mol Med,2014, 33(5): 1261-1267. [17] MENGES T, ENGEL J, WELTERS I, et al. Changes in blood lymphocyte populations after multiple trauma: association with posttraumatic complications[J]. Crit Care Med,1999,27(4): 733-740.
