Combined Features Based on Preoperative Controlling Nutritional Status Score and Circulating Tumour Cell Status Predict Prognosis for Colorectal Cancer Patients Treated with Curative Resection
Combined Features Based on Preoperative Controlling Nutritional Status Score and Circulating Tumour Cell Status Predict Prognosis for Colorectal Cancer Patients Treated with Curative Resection
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基于术前控制营养状况评分和循环肿瘤细胞状态的组合特征可预测接受根治性切除治疗的结直肠癌患者的预后
DOI：
10.7150/ijbs.33671
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发表时间：
2019-01-01
影响因子：
9.2
通讯作者：
Xiong, Bin
中科院分区：
文献类型：
--
作者：
Yang, Chaogang;Wei, Chen;Xiong, Bin
背景资料：术前控制性营养状态（CONUT）评分和循环肿瘤细胞（CTC）状态与结直肠癌（CRC）预后不良相关。本研究的目的是确定CONUT和CTC（CONUT-CTC）的组合是否可以更好地预测结直肠癌根治性切除治疗的患者的预后。研究方法：回顾性计算了2015年至2017年在武汉大学中南医院接受根治性切除术的160例CRC患者的术前CONUT评分。通过CTCBIOPSY®装置从5 ml外周静脉血计数术前CTC计数。根据术前CONUT和CTC状态，将患者分为三组：CONUT-CTC（0）、CONUT-CTC（1）和CONUT-CTC（2）。评估CONUT评分与CTC之间的关系，以及CONUT-CTC状态与临床病理因素和生存率的相关性。结果：术前CTC数目及阳性率与术前CONUT评分呈正相关（P<0.01）。CONUT-CTC评分升高与肿瘤浸润深度（P=0.025）、淋巴管浸润（P=0.002）、静脉浸润（P<0.001）和pTNM分期升高（P=0.033）显著相关。Kaplan-Meier分析和对数秩检验显示，CONUT-CTC评分为0、1和2分的CRC患者的无复发生存期（RFS）和癌症特异性生存期（CSS）显著降低（P<0.001）。在pTNM分期分层分析中，CONUT-CTC评分高与III期患者的较差（P<0.001）和CSS（P<0.001）显著相关，但与II期患者的预后无关（RFS：P=0.077; CSS：P<0.090）。进一步的单因素和多因素分析显示，CONUT-CTC是影响患者RFS [风险比（HR）=2.66，95%CI：1.79-3.96，P<0.001]和CSS（HR=3.75，95%CI：2.14-6.57，P<0.001）的独立因素。在时间依赖性受试者工作特征（ROC）分析中，CONUT-CTC评分预测RFS和CSS的ROC曲线下面积（AUC）高于术前CONUT评分或CTC状态。结论：术前CONUT-CTC评分与根治性切除治疗的CRC患者的肿瘤进展和预后不良相关，表明结合术前宿主免疫营养状态和CTC检测可以获得更好的CRC预后信息。
Background: The preoperative controlling nutritional status (CONUT) score and circulating tumour cell (CTC) status are associated with poor prognosis of colorectal cancer (CRC). The aim of the present study is to determine whether the combination of CONUT and CTC (CONUT-CTC) could better predict the prognosis of CRC patients treated with curative resection. Methods: Preoperative CONUT score was retrospectively calculated in 160 CRC patients who underwent curative resection at Zhongnan Hospital of Wuhan University from 2015 to 2017. Preoperative CTC counts were enumerated from 5 ml peripheral vein blood by a CTCBIOPSY® device. According to the preoperative CONUT and CTC status, the patients were divided into three groups: CONUT-CTC (0), CONUT-CTC (1) and CONUT-CTC (2). The relationship between CONUT score and CTC, as well as the associations of CONUT-CTC status with clinicopathological factors and survival, were evaluated. Results: Preoperatively, the number and positive rate of CTC were positively correlated with the preoperative CONUT score (P<0.01). An elevated CONUT-CTC score was significantly associated with deeper tumour invasion (P=0.025), lymphatic vessel invasion (P=0.002), venous invasion (P<0.001) and higher pTNM stage (P=0.033). Kaplan-Meier analysis and log-rank tests revealed significant decreases in recurrence-free survival (RFS) and cancer-specific survival (CSS) among CRC patients with CONUT-CTC score of 0, 1 and 2 (P<0.001). In pTNM stage-stratified analysis, high CONUT-CTC score was significantly associated with the poor (P<0.001) and CSS (P<0.001) of patients with stage III disease, but not correlated with the prognosis of patients with stage II disease (RFS: P=0.077; CSS: P<0.090). Further univariate and multivariate analyses showed that CONUT-CTC was an independent factor affecting patients' RFS [hazard ratio (HR)=2.66, 95% confidence interval (CI):1.79-3.96, P<0.001] and CSS (HR=3.75, 95%CI: 2.14-6.57, P<0.001). In time-dependent receiver operating characteristics (ROC) analyses, CONUT-CTC score had a higher area under the ROC curve (AUC) for the prediction of RFS and CSS than did preoperative CONUT score or CTC status. Conclusion: The preoperative CONUT-CTC score is associated with tumour progression and poor prognosis in patients with CRC treated with curative resection, indicating that better information on CRC prognosis could be obtained from combined preoperative host immune-nutritional status and CTC detection.