术前NLR与合伴2型糖尿病的结直肠癌患者临床病理特征及预后相关性研究
The correlation between the preoperative NLR and clinicopathologic features and prognosis in colorectal cancer patients withtype 2 diabetes mellitus
牟娟丽 1王倩 1商建 1程洁 1劳垚佳 1黄凯 1胡凡 1奉佳辉 1林梦璐 1林军1
作者信息
- 1. 武汉大学中南医院消化内科、湖北省肠病医学临床研究中心、湖北省肠病重点实验室,湖北武汉 430071
- 折叠
摘要
[目的]以术后总生存时间(OS)为研究主要终点目标,探讨术前中性粒细胞/淋巴细胞比值(NLR)与合伴2型糖尿病(T2DM)的结直肠癌(CRC)患者的临床病理特征及预后相关性.[方法]收集178例合伴T2DM的CRC手术治疗患者临床资料和随访术后生存信息,根据预后分为存活组和死亡组,比较两组患者临床肿瘤病理特征差异性,COX回归模型分析预后影响因素,Spearman秩相关系数研判术前NLR与生存阳性因素的相关性.运用ROC曲线确定NLR截值,分为高NLR组和低NLR组,采用Kaplan-Meier法和Log-rank法进行生存分析.[结果]①存活组与死亡组患者比较,术前NLR、年龄、肿瘤长径、浸润深度、淋巴结转移、远处转移、TNM分期、手术类型差异均具有统计学意义(P＜0.05).②COX回归分析表明术前NLR、肿瘤长径、浸润深度、淋巴结转移、远处转移、TNM分期、手术类型是合伴T2DM的CRC患者死亡的危险因素(P＜0.05),其中术前NLR(HR=1.129,95％CI:1.051～1.213,P=0.001)、浸润深度(HR=3.402,95％CI:1.149～10.070,P=0.027)、淋巴结转移(HR=2.970,95％CI:1.237～7.134,P=0.015)、远处转移(HR=9.250,95％CI:4.308～19.863,P＜0.001)系其独立危险因素.③Spearman秩相关系数分析提示术前NLR与浸润深度、淋巴结转移、TNM分期呈正相关(rs=0.336,0.233,0.318,P＜0.05).④术前NLR预测合伴T2DM的CRC患者死亡的曲线下面积(AUC)为0.738,最佳截点为2.53.⑤高NLR组与低NLR组相比,术后OS明显缩短(44.52±3.67):(69.50±2.13)个月,5年生存率更低(48.7％∶86.6％,x2=33.282,P＜0.0001).[结论]术前NLR与合伴T2DM的CRC患者的浸润深度、淋巴结转移、TNM分期呈正相关,高NLR组较低NLR组的OS明显缩短、5年生存率更低,为预后不良的重要预测因子及独立危险因素.
Abstract
[Objective]To investigate the association between preoperative neutrophil to lymphocyte ratio(NLR)and clinicopathologic characteristics and prognosis in colorectal cancer(CRC)patients with type 2 diabetes mellitus(T2DM),with overall survival time(OS)of postoperative as the primary end point.[Methods]Clinical data and follow-up information of 178 CRC patients with T2DM who underwent surgery were collected.The patients were divided into survival group and death group to compare with clinicopatho-logical characteristics between them.The COX regression model was employed to analyze the risk factors,and the Spearman rank correlation coefficient was applied to assess the association between the preopera-tive NLR and the prognosis factors.The cut-off value of NLR was determined using the receiver operating characteristic(ROC)curve,and then divided all patients into high NLR and low NLR groups.The survival analysis was performed by Kaplan-Meier method and Log-rank method.[Results]①Significant differences were detected respectively in the preoperative NLR,age,tumor size,depth of invasion,lymph node metasta-sis,distant metastasis,TNM stage and surgical type when comparing the survival and death groups(P＜0.05).②COX regression analysis indicated that preoperative NLR,tumor size,depth of invasion,lymph node metastasis,distant metastasis,TNM stage and surgical type were risk factors for mortality in CRC pa-tients with T2DM(P＜0.05),among which preoperative NLR(HR=1.129,95％CI:1.051-1.213,P=0.001),depth of invasion(HR=3.402,95％CI:1.149-10.070,P=0.027),lymph node metastasis(HR=2.970,95％CI:1.237-7.134,P=0.015)and distant metastasis(HR=9.250,95％CI:4.308-19.863,P＜0.001)were independent risk factors.③Spearman Rank correlation coefficient analysis demonstrated that preoperative NLR was positively associated with invasion depth,lymph node metastasis,and TNM stage(rs=0.336,0.233,0.318,P＜0.05).④The area under the curves(AUC)of preoperative NLR for predicting the mortality of CRC patients with T2DM was 0.738 and the optimal cut-off value of NLR was 2.53.⑤The high NLR group had significantly worse postoperative OS(44.52±3.67)vs(69.50+2.13)months and lower 5-year survival(48.7％vs 86.6％,x2=33.282,P＜0.0001).[Conclusion]Preoperative NLR was positively correlated with depth of invasion,lymph node metastasis and TNM stage in CRC patients with T2DM,and the high NLR group had significantly shorter OS and 5-year survival.Preoperative NLR was an important predictor and independent risk factor for poor prognosis.
关键词
结直肠癌/2型糖尿病/中性粒细胞/淋巴细胞比值/临床病理特征/预后Key words
colorectal cancer/type 2 diabetes mellitus/neutrophil to lymphocyte ratio/clinicopathologi-cal features/prognosis引用本文复制引用
基金项目
湖北省卫生健康委联合基金项目(WJ2019H082)
出版年
2024
NETL
NSTL
万方数据