Zhang Lu-Ning, Xiao Weiwei, OuYang Pu-Yun, You Kaiyun, Zeng Zhi-Fan, Ding Pei-Rong, Pan Zhi-Zhong, Xu Rui-Hua, Gao Yuan-Hong
Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No. 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, China.
Department of Oncology, The Second Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Tumour Biol. 2015 Sep;36(10):8213-9. doi: 10.1007/s13277-015-3560-6. Epub 2015 May 21.
It remains controversial whether adjuvant therapy should be delivered to pathological T3N0M0 rectal cancer without neoadjuvant chemoradiotherapy. Thus identification of patients at high risk is of particular importance. Herein, we aimed to evaluate whether the absolute peripheral blood monocyte count can stratify the pathological T3N0M0M0 rectal cancer patients in survival. A total of 270 pathological T3N0M0 rectal cancer patients with total mesorectal excision-principle radical resection were included. The optimal cut-off value of preoperative monocyte count was determined by receiver operating characteristic curve analysis. Overall survival and disease-free survival between low- and high-monocyte were estimated by Kaplan-Meier method and Cox regression model. The optimal cut-off value for monocyte count was 595 mm(3). In univariate analysis, patients with monocyte counts higher than 595/mm(3) had significantly inferior 5-year overall survival (79.2 vs 94.2 %, P = 0.006) and disease-free survival (67.8 vs 86.0 %, P < 0.001). With adjustment for the known covariates, monocyte count remained to be associated with poor overall survival (HR = 2.55, 95 % CI 1.27-5.10; P = 0.008) and disease-free survival (HR = 2.63, 95 % CI 1.48-4.69; P = 0.001). Additionally, the significant association of monocyte count with disease-free survival was hardly influenced in the subgroup analysis, whereas this correlation was restricted to the males and patients with normal carcinoembryonic antigen (CEA) level (<5 μg/L), tumor grade II, and with adjuvant therapy. High preoperative monocyte count is independently predictive of worse survival of pathological T3N0M0 rectal cancer patients without neoadjuvant chemoradiotherapy. Postoperative adjuvant therapy might be considered for patients with high-monocyte count.
对于未接受新辅助放化疗的病理T3N0M0直肠癌患者是否应给予辅助治疗仍存在争议。因此，识别高危患者尤为重要。在此，我们旨在评估外周血单核细胞绝对计数是否能够对病理T3N0M0直肠癌患者的生存情况进行分层。总共纳入了270例行全直肠系膜切除原则根治性切除术的病理T3N0M0直肠癌患者。通过受试者工作特征曲线分析确定术前单核细胞计数的最佳临界值。采用Kaplan-Meier法和Cox回归模型评估低单核细胞组和高单核细胞组之间的总生存期和无病生存期。单核细胞计数的最佳临界值为595/mm³。单因素分析显示，单核细胞计数高于595/mm³的患者5年总生存率（79.2%对94.2%，P = 0.006）和无病生存率（67.8%对86.0%，P < 0.001）显著较差。在对已知协变量进行校正后，单核细胞计数仍与较差的总生存期（HR = 2.55，95%CI 1.27 - 5.10；P = 0.008）和无病生存期（HR = 2.63，95%CI 1.48 - 4.69；P = 0.001）相关。此外，在亚组分析中，单核细胞计数与无病生存期的显著关联几乎不受影响，而这种相关性仅限于男性以及癌胚抗原（CEA）水平正常（<5μg/L）、肿瘤分级为II级且接受辅助治疗的患者。术前单核细胞计数高是未接受新辅助放化疗的病理T3N0M0直肠癌患者生存较差的独立预测因素。对于单核细胞计数高的患者，可考虑术后辅助治疗。
