A Preoperative Neutrophil to Lymphocyte Ratio of 3 Predicts Disease-Free Survival After Curative Elective Colorectal Cancer Surgery
A Preoperative Neutrophil to Lymphocyte Ratio of 3 Predicts Disease-Free Survival After Curative Elective Colorectal Cancer Surgery
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DOI：
10.1097/sla.0000000000000216
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发表时间：
2014-08-01
影响因子：
9
通讯作者：
Jenkins, John T.
中科院分区：
文献类型：
--
作者：
Malietzis, George;Giacometti, Marco;Jenkins, John T.
目的：本研究旨在确定中性粒细胞与淋巴细胞比率（NLR）作为非转移性结直肠癌患者接受根治性切除术的预后指标的作用。背景：NLR反映了系统性炎症反应，有证据表明术前NLR高于5.0与结直肠癌患者生存率较差相关。纳入了2006年至2011年期间诊断为非转移性结直肠腺癌并接受手术切除的506例连续患者的数据。采用受试者工作特征曲线分析确定与无病生存期和总生存期相关的NLR的最佳值。采用单变量和多变量考克斯回归模型，以确定NLR的作用后，分层的几个临床病理因素。患者按照标准化方案随访至2013年2月。结果：中位随访时间为45个月[四分位距，21-65]。多变量考克斯回归分析确定NLR大于3是无病生存期的独立预后因素（比值比= 2.41; 95%置信区间= 1.12-5.15; P = 0.024），但不是总生存期的独立预后因素（比值比= 1.23; 95%置信区间= 0.80-1.90; P = 0.347）。一个高NLR显着相关的年龄较大，较高的T和N阶段，存在微血管浸润，术前低白蛋白水平，和较高的阿萨（美国麻醉医师协会）状态的patient.Conclusions：对于结直肠癌患者，术前NLR超过3.0可能是一个独立的无病生存的预后因素。考虑到这一点，除了良好的预后变量可能会改善识别过程中复发风险较高的患者谁会受益于辅助治疗或更频繁的监测，从而提供更个性化的癌症护理。
Objective: This study aims to determine the role of the neutrophil to lymphocyte ratio (NLR) as a prognostic marker for patients with nonmetastatic colorectal cancer undergoing curative resection.Background: An NLR reflects a systematic inflammatory response, with some evidence suggesting that an elevated preoperative NLR of more than 5.0 is associated with poorer survival in patients with colorectal cancer.Methods: Data from 506 consecutive patients with a diagnosis of nonmetastatic colorectal adenocarcinoma undergoing surgical resection between 2006 and 2011 were included. Receiver operating characteristic curve analysis was used to identify the optimal value for NLR in relation to disease-free and overall survival. Univariate and multivariate Cox regression models were used to determine the role of NLR after stratification by several clinicopathological factors. Patients were followed by a standardized protocol until February 2013.Results: Median follow-up was 45 months [interquartile range, 21-65]. Multivariate Cox regression analysis identified an NLR of more than 3 as an independent prognostic factor for disease-free survival (odds ratio = 2.41; 95% confidence interval = 1.12-5.15; P = 0.024) but not for overall survival (odds ratio = 1.23; 95% confidence interval = 0.80-1.90; P = 0.347). A high NLR was significantly associated with older age, higher T and N stages, the presence of microvascular invasion, low preoperative albumin levels, and higher ASA (American Society of Anesthesiologists) status of the patient.Conclusions: For patients with colorectal cancer, a preoperative NLR of more than 3.0 may be an independent prognostic factor for disease-free survival. Considering this in addition to well-established prognostic variables may improve the processes of identifying patients at higher risk of recurrence who would benefit from adjuvant therapies or more frequent surveillance, thereby providing more personalized cancer care.