术前外周血中性粒细胞和淋巴细胞比值与中老年结直肠癌患者临床病理特征及预后的关系

摘要

目的 探讨术前外周血中性粒细胞与淋巴细胞比值(NLR)与中老年结直肠癌患者临床病理特征及预后的关系. 方法 回顾性分析2011年1月至2013年6月南京医科大学第一附属医院212例接受外科手术,且术后病理诊断为结直肠癌的中老年患者临床资料.根据年龄将患者分为46～65岁组130例和66～89岁组82例,采用受试者工作特征(ROC)曲线确定NLR最佳截点,将两组患者分别分为高NLRC＞3.13)组和低NLR(≤3.13)组,比较两组间的临床病理特征并进行预后分析. 结果 46～65岁组和66～89岁组患者中,高NLR组与低NLR组比较,性别、肿瘤生长部位、浸润深度、癌栓、淋巴转移、远处转移、TNM分期等差异无统计学意义(均P＞0.05).66～89岁患者中,高NLR组与低NLR组合并糖尿病的差异有统计学意义(均P＜0.05).212例患者的1、2、3年生存率分别为96.2％(204例)、87.7％(186例)、74.5％(158例).46～65岁组低NLR组1、2、3年生存率分别为98.8％(85/86)、90.7％(78/86)、84.9％(73/86),高NLR组1、2、3年生存率分别为95.5％(42/44)、84.1％(37/44)、72.7％(32/44),差异有统计学意义(均P＜0.05).66～89岁组低NLR组1、2、3年生存率分别为95.7％(44/46)、89.1％(41/46)、73.9％(34/46),高NLR组1、2、3年生存率分别为91.7％(33/36)、83.3％(30/36)、52.8％(19/36),差异有统计学意义(P＜0.05).Cox多因素预后分析结果表明,NLR和TNM分期为影响中老年结直肠癌患者预后的独立危险因素(P＜0.05和P＜0.01). 结论 术前NLR＞3.13提示中老年结直肠癌患者的预后较差.%Objective To evaluate the relationship of preoperative neutrophil-lymphocyte ratio (NLR) with clinicopathological features and prognosis of colorectal cancer in middle-aged and elderly patients.Methods A retrospective analysis was performed in 212 patients with colorectal cancer in the First Affiliated Hospital of Nanjing Medical University from January 2011 to June 2013.All patients were divided into middle-aged group (46-65 year old,n=130) and old-aged group (66-89 year old,n=82),The optimal cut-off point of NLR was identified by the area under receiver operating characteristic curve,while NLR ＞ 3.13 and NLR≤3.13 were classified as high and low NLR group.The clinicopathological features and prognosis between the two groups were compared.Results There was no difference in gender,tumor growth site,depth of invasion,tumor embolus,lymphatic metastasis,distant metastasis,TNM stage between low and high NLR group (allP＞ 0.05).However,the difference between high NLR group and low NLR group in old-aged group with diabetes mellitus was statistically significant (P＜0.05).The 1-,2-,and 3-year survival rate of the overall 212 patients were 96.2％ (204/212),87.7％ (186/212) and 74.5％ (158/212) In middle-aged group,the 1-,2-,and 3-year survival rates were 98.8％ (85/86),90.7％ (78/86) and 84.9％ (73/86) respectively in low NLR group,but 95.5％ (42/44),84.1％ (37/44) and 72.7％ (32/44) respectively in high NLR group,(allP＜0.05).In old-aged group,the 1-,2-,and 3-year survival rates were 95.7％ (44/46),89.1％ (41/46) and 73.9％ (34/46) respectively in low NLR group,but 91.7％ (33/ 36),83.3％ (30/36) and 52.8％ (19/36) respectively in high NLR group (all P＜0.05).Cox regression showed that TNM stage and NLR were independent risk factors for the prognosis of the middle-aged and elderly patients with colorectal cancer (P＜0.05 or P＜0.01).Conclusions Preoperative NLR ＞ 3.13 suggest that the prognosis is poor in middle-aged and elderly patients with colorectal cancer.