Cumulative perioperative lymphocyte/C-reactive protein ratio as a predictor of the long-term outcomes of patients with colorectal cancer
Cumulative perioperative lymphocyte/C-reactive protein ratio as a predictor of the long-term outcomes of patients with colorectal cancer
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DOI：
10.1007/s00595-021-02291-9
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发表时间：
2021-05-05
期刊：
影响因子：
2.5
通讯作者：
Nakatani, Kaname
中科院分区：
文献类型：
--
作者：
Okugawa, Yoshinaga;Toiyama, Yuji;Nakatani, Kaname
目的全身炎症反应影响肿瘤的发生发展，围手术期应激影响结直肠癌患者的生存。我们开发了一个系统来累积评估围手术期炎症反应，并比较各种累积炎症和营养标志物在结直肠癌患者中的预后价值。方法采用梯形面积法对307例结直肠癌手术患者围手术期累积标志物进行评估，并对结果进行统计学分析。结果累积淋巴细胞与C反应蛋白（CRP）比值（LCR）预测生存率的准确性高于其他成熟指标（敏感性：80.0%，特异性：69.3%;曲线下面积（AUC）：0.779; P < 0.001）。低累积LCR与疾病发展相关因素相关，包括未分化组织学、晚期T分期、淋巴结转移、远处转移和晚期TNM分期分类。累积LCR降低是总生存期（OS）（风险比（HR）：5.21，95%置信区间[CI] 2.42-11.2; P < 0.0001）和无病生存期（DFS）（HR：1.88，95% CI 1.07-3.31; P = 0.02）的独立预后因素，其预后意义在不同的临床环境中得到验证。累积LCR与术中出血量呈负相关（P < 0.0001，R = 0.4）。对累积LCR和术前LCR的综合分析有助于对CRC患者的肿瘤学结局进行风险分层。结论累积LCR在结直肠癌术后管理中具有重要价值。
Purpose Systemic inflammatory response influences cancer development and perioperative surgical stress can affect the survival of patients with colorectal cancer (CRC). We developed a system to cumulatively assess perioperative inflammatory response and compare the prognostic value of various cumulative inflammatory and nutritional markers in patients with CRC. Methods We assessed perioperative cumulative markers using the trapezoidal area method in 307 patients who underwent surgery for CRC and analyzed the results statistically. Results The cumulative lymphocyte to C-reactive protein (CRP) ratio (LCR) predicted survival more accurately than other well-established markers (sensitivity: 80.0%, specificity: 69.3%; area under the curve (AUC): 0.779; P < 0.001). A low cumulative LCR was correlated with factors associated with disease development, including undifferentiated histology, advanced T stage, lymph node metastasis, distant metastasis, and advanced TNM stage classification. A decreased cumulative LCR was an independent prognostic factor for both overall survival (OS) (Hazard Ratio (HR):5.21, 95% confidence interval [CI] 2.42-11.2; P < 0.0001) and disease-free survival (DFS) (HR: 1.88, 95% CI 1.07-3.31; P = 0.02), and its prognostic significance was verified in a different clinical setting. The cumulative LCR was correlated negatively with the intraoperative bleeding volume (P < 0.0001, R = (-)0.4). Combined analysis of cumulative and preoperative LCR could help stratify risk for the oncological outcomes of CRC patients. Conclusions The findings of this study demonstrate the value of the cumulative LCR in the postoperative management of patients with CRC.