目的 探讨全身免疫炎症指数(systemic immune-inflammation index,SII)联合中性粒细胞与单核细胞比值(neutrophil-monocyte ratio,NMR)对老年结肠癌患者术后吻合口漏的预测价值.方法 回顾性分析2018年1月至2023年10月期间就诊于兰州大学第一医院普通外科的493例老年结肠癌患者的临床相关资料,根据吻合口漏发生与否分为吻合口漏组(n=29)和非吻合口漏组(n=464),比较2组在不同时间点的SII和NMR差异;采用受试者工作特征(receiver operating characteristic,ROC)曲线下面积(area under the curve,AUC)比较SII、NMR以及两者联合对老年结肠癌患者术后发生吻合口漏的预测价值;并分析老年结肠癌患者术后发生吻合口漏的独立危险因素.结果 吻合口漏组老年结肠癌患者术后第3和第5天的SII和NMR均高于非吻合口漏组(P＜0.05).ROC曲线分析显示,术后第3天的SII、术后第5天的NMR和两者联合预测吻合口漏的AUC分别为0.613、0.743和0.750.DeLong检验结果提示其中术后第5天的NMR联合术后第3天的SII的AUC与术后第3天SII的AUC值差异有统计学意义(P=0.047).多因素logistic回归分析显示,患者年龄、男性、合并糖尿病、术前放化疗、肿瘤位于左半结肠、术后第3天SII以及术后第5天NMR是老年结肠癌患者术后发生吻合口漏的独立危险因素(均P＜0.05).结论 术后第3天SII联合术后第5天NMR、术后第3天SII和术后第5天NMR均对老年结肠癌患者术后吻合口漏有预测价值,SII和NMR有潜能作为预测老年结肠癌患者术后吻合口漏的重要指标.
The predictive value of systemic immune inflammation index combined with neutrophil to monocyte ratio for postoperative anastomotic leakage in elderly colon cancer patients
Objective To explore the predictive value of systemic immune-inflammation index(SII)combined with neutrophil-monocyte ratio(NMR)on postoperative anastomotic leakage in elderly colon cancer.Methods The clinical data of 493 elderly colon cancer patients who attended the Department of General Surgery of the First Hospital of Lanzhou University from January 2018 to October 2023 were retrospectively analysed,and divided into an anastomotic leakage group(n=29)and a non-anastomotic leakage group(n=464)according to the occurrence of anastomotic leakage or not,and the differences between the two groups in terms of SII and NMR at different time points were compared.Area under the curve(AUC)of receiver operating characteristic(ROC)was used to compare the predictive value of SII,NMR and the combination of the two on the occurrence of anastomotic leakage after surgery in elderly colon cancer patients.Logistic regression was used to analyse the independent risk factors for postoperative anastomotic leakage in elderly colon cancer patients.Results The SII and NMR in the anastomotic leakage group were higher than those in the non-anastomotic leakage group on the 3 rd and 5 th day after operation(P＜0.05).ROC curve analysis showed that the AUC values for SII on postoperative day 3,NMR on postoperative day 5,and the combination of the two to predict anastomotic leakage were 0.613,0.743,and 0.750,respectively.The results of DeLong's test suggested that the difference between the AUC values of NMR on postoperative day 5 combined with SII on postoperative day 3 and SII on postoperative day 3 was statistically significant(P=0.047).Multifactorial logistic regression analysis showed that age,male,diabetes,preoperative radiotherapy and chemotherapy,tumor located in the left colon,SII on postoperative day 3,and NMR on postoperative day 5 were independent risk factors for postoperative anastomotic leakage in elderly patients with colorectal cancer(all P＜0.05).Conclusions Postoperative day 3 SII combined with postoperative day 5 NMR,postoperative day 3 SII,and postoperative day 5 NMR all have predictive value for postoperative anastomotic leakage in elderly patients with colorectal cancer.Both have the potential to serve as important predictors of postoperative anastomotic leakage in elderly patients with colon cancer.
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