Relationship between Serum ALB,NLR,AFR and Postoperative Prognosis of NOSES in Patients with Early Colorectal Cancer
Objective To investigate the relationship between serum albumin(ALB),neutrophil to lym-phocyte ratio(NLR),albumin to fibrinogen ratio(AFR)and prognosis of patients with early colorectal cancer after natural orifice specimen extraction surgery(NOSES).Methods Total 76 patients with early colorectal cancer admitted to our hospital from February 2019 to March 2020 were included in the study,and the levels of ALB,NLR and AFR in patients with different clinical characteristics were compared.Ac-cording to the postoperative follow-up,the patients were divided into the progressive group and the stable group,and the serum levels of ALB,NLR and AFR were compared between the two groups.Patients were divided into the high level group and the low level group,taking the mean levels of ALB,NLR and AFR as the critical value.The follow-up period was up to February 2024.Kaplan Meier method was used to plot the survival curve to analyze the cumulative survival rate of patients.Receiver operating curve(ROC)was used to analyze the value of the levels of ALB,NLR and AFR in evaluating the prognosis.Results Up to the last follow-up date,recurrence or metastasis occurred in 23 of 76 patients,with a recurrence rate of 30.26％.Among them,11 cases died due to tumor progression,and the mortality rate was 14.47％.The levels of ALB and AFR in patients without lymph node metastasis and moderate to high differentiation were higher than those in patients with lymph node metastasis and low differentiation.The level of NLR in patients without lymph node metastasis and moderate to high differentiation was lower than that in pa-tients with lymph node metastasis and low differentiation,and the difference was statistically significant(P＜0.05).The levels of ALB and AFR in the stable group were higher than those in the progressive group,and the level of NLR in the stable group was lower than that in the progressive group,with statis-tical significance(P＜0.05).The cumulative survival rate in the high level group of ALB was higher than that in the low level group of ALB,and the difference was statistically significant(Logrankx2=5.790,P=0.016).The cumulative survival rate in patients of the high level group of NLR was lower than that in the low level group of NLR,and the difference was statistically significant(Logrankx2=4.663,P=0.034).The cumulative survival rate in patients of the high level group of AFR was higher than that in the low level group of AFR,and the difference was statistically significant(Logrankx2=4.319,P=0.045).ROC curves of ALB,NLR and AFR for predicting postoperative prognosis of patients with colorectal canc-er were plotted,and the results showed that the AUC of ALB,NLR and AFR were 0.775,0.797 and 0.704,respectively,and the AUC of combined detection was 0.853,with an accuracy of 87.3％,which was higher than that of single index(P＜0.05).Conclusion The postoperative prognosis of NOSES in pa-tients with early colorectal cancer is related to the severity of the patients'disease.Serum ALB,NLR,and AFR are the influencing factors for prognosis,and the combined detection has high accuracy in predicting the prognosis of patients.
Colorectal cancerAlbuminNeutrophil to lymphocyte ratioAlbumin to fibrinogen ratioNatural orifice specimen extraction surgeryPrognosis
NETL
NSTL
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