Li Yaqi, Jia Huixun, Yu Wencheng, Xu Ye, Li Xinxiang, Li Qingguo, Cai Sanjun
Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
Int J Cancer. 2016 Jul 1;139(1):220-31. doi: 10.1002/ijc.30071. Epub 2016 Mar 18.
Increasing evidence indicates that inflammation plays a vital role in tumorigenesis and progression. However, the prognostic value of inflammatory biomarkers in colorectal cancer (CRC) has not been established. In this study, a retrospective analysis was conducted in patients with CRC in Fudan University Shanghai Cancer Center (FUSCC) between April 1, 2007 and April 30, 2014, and 5,336 patients were identified eligible. Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and albumin/globulin ratio (AGR) were analyzed. Kaplan-Meier analysis was used to calculate the 5-year overall survival (OS) and disease-free survival (DFS). Cox regression analysis was performed to assess the prognostic factors. Nomograms were established to predict OS and DFS, and Harrell's concordance index (c-index) was adopted to evaluate prediction accuracy. As results, the 5-year OS was 79.2% and the 5-year DFS was 56.0% in the cohort. Patients were stratified into 2 groups by NLR (≤2.72 and >2.72), PLR (≤219.00 and >219.00), LMR (≤2.83 and >2.83) and AGR (<1.50 and ≥1.50). Patients with NLR > 2.72, PLR > 219.00, LMR ≤ 2.83 and AGR < 1.50 were significantly associated with decreased OS and DFS (p < 0.001). Multivariate analysis indicated that NLR, LMR and AGR were independent factors of OS (p = 0.047, p = 0.008 and p < 0.001, respectively) and DFS (p = 0.009, p < 0.001 and p = 0.008, respectively). In addition, nomograms on OS and DFS were established according to all significant factors, and c-indexes were 0.765 (95% CI: 0.744-0.785) and 0.735 (95% CI: 0.721-0.749), respectively. Nomograms based on OS and DFS can be recommended as practical models to evaluate prognosis for CRC patients.
越来越多的证据表明，炎症在肿瘤发生和进展中起着至关重要的作用。然而，炎症生物标志物在结直肠癌（CRC）中的预后价值尚未明确。本研究对2007年4月1日至2014年4月30日期间复旦大学附属肿瘤医院（FUSCC）的CRC患者进行了回顾性分析，共纳入5336例符合条件的患者。分析了中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）、淋巴细胞与单核细胞比值（LMR）以及白蛋白/球蛋白比值（AGR）。采用Kaplan-Meier分析计算5年总生存率（OS）和无病生存率（DFS）。进行Cox回归分析以评估预后因素。建立了预测OS和DFS的列线图，并采用Harrell一致性指数（c指数）评估预测准确性。结果显示，该队列的5年OS为79.2%，5年DFS为56.0%。根据NLR（≤2.72和>2.72）、PLR（≤219.00和>219.00）、LMR（≤2.83和>2.83）和AGR（<1.50和≥1.50）将患者分为两组。NLR>2.72、PLR>219.00、LMR≤2.83和AGR<1.50的患者的OS和DFS显著降低（p<0.001）。多因素分析表明，NLR、LMR和AGR是OS（分别为p = 0.047、p = 0.008和p<0.001）和DFS（分别为p = 0.009、p<0.001和p = 0.008）的独立因素。此外，根据所有显著因素建立了OS和DFS的列线图，c指数分别为0.765（95%CI：0.744 - 0.785）和0.735（95%CI：0.721 - 0.749）。基于OS和DFS的列线图可作为评估CRC患者预后的实用模型。
