Circulating CEA-dNLR score predicts clinical outcome of metastatic gallbladder cancer patient
Circulating CEA-dNLR score predicts clinical outcome of metastatic gallbladder cancer patient
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DOI：
10.1002/jcla.22684
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发表时间：
2019-02-01
影响因子：
2.7
通讯作者：
Lu, Jun
中科院分区：
文献类型：
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作者：
Du, Jing-Hui;Lu, Jun
背景：胆囊癌相关炎症促进胆囊肿瘤的发生和转移。循环中炎症相关细胞和蛋白的水平及其比值可以反映GBC患者慢性炎症的严重程度，是mGBC的候选预后生物标志物。材料与方法检测220例mGBC患者治疗前循环免疫细胞、纤维蛋白原（Fib）、白蛋白（Alb）、前白蛋白（pAlb）水平，计算外周血嗜中性粒细胞/淋巴细胞比值（NLR）、衍生嗜中性粒细胞/淋巴细胞比值（dNLR）、淋巴细胞/单核细胞比值（LMR）、血小板/淋巴细胞比值（PLR）、白蛋白/纤维蛋白原比值（AFR）、和Fib-to-pAlb比值（FPR）的检测结果。对这些患者进行3年随访，我们使用X-tile软件、Kaplan-Meier曲线、考克斯回归和时间依赖性受试者工作特征（ROC）来研究这些生物标志物与这些患者3年总生存率（OS）之间的可能关联。结果高pAlb和LMR患者的OS分别显著上级低pAlb和LMR患者。然而，高CEA、dNLR和FPR的患者的生存率明显低于低这些生物标志物水平的患者。CEA和dNLR的时间依赖性ROC曲线下面积（AUC）分别高于pAlb、LMR和FPR。此外，CEA-dNLR评分较高（1分校正HR = 3.09，95% CI = 1.01-4.51;评分2的校正HR = 4.99，95%CI = 2.32-7.21）与患者生存期降低显著相关，预测mGBC患者临床结局的评分AUC为0.756，且分别显著高于CEA和dNLR单药组。结论治疗前CEA dNLR评分对mGBC患者OS的预测上级其他生物标志物，是mGBC患者的独立预后因素。
Background Cancer-related inflammation promotes gallbladder tumorigenesis and metastasis of gallbladder cancer (mGBC). The levels of circulating inflammatory-related cell and protein as well as the ratios of them may imply the severity of chronic inflammation in GBC patients, and all of them are candidate prognostic biomarkers for mGBC. Materials and methods In our study, pre-treatment circulating immune cell, fibrinogen (Fib), albumin (Alb), and pre-albumin (pAlb) were detected in 220 mGBC patients, and we calculated neutrophil-to-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (dNLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), Alb-to-Fib ratio (AFR), and Fib-to-pAlb ratio (FPR) replying on the detection. Three years' follow-up was carried out in those patients, and we investigated the possible associations between those biomarkers and three years' overall survival (OS) of these patients using X-tile software, Kaplan-Meier curve, Cox regression, and time-dependent receiver operating characteristics (ROC). Results Our results showed that OS of the patients with high pAlb and LMR was significantly superior to the cases with the low biomarkers, respectively. However, survival of the cases with high CEA, dNLR, and FPR was significantly inferior to the patients with low levels of those biomarkers. Area under the curve (AUC) of time-dependent ROC of CEA and dNLR was higher than pAlb, LMR, and FPR, respectively. Additionally, higher CEA-dNLR score (adjusted HR = 3.09, 95% CI = 1.01-4.51 for the score one; adjusted HR = 4.99, 95% CI = 2.32-7.21 for the score two) was significantly associated with reduced survival of the patients, and AUC of the score for predicting clinical outcome of mGBC patients was 0.756, and it was significantly higher than the single CEA and dNLR, respectively. Conclusion Our findings implied that pretreatment CEA-dNLR score was superior to the other biomarkers to predict OS of mGBC patients, and it was an independent prognostic factor for the disease.