Jiang Huihong, Wang Hui, Li Ajian, Tang Erjiang, Chen Ying, Wang Aili, Deng Xiaxing, Lin Moubin
Department of Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China.
Department of General Surgery, Center for Translational Medicine, Yangpu Hospital, Tongji University School of Medicine, Shanghai 200090, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2017 May 25;20(5):550-554.
To investigate the impact of neutrophil-to-lymphocyte ratio(NLR) on the prognosis of patients with locally advanced colorectal cancer (LACRC).
Clinicopathological data of 684 patients with stage II(-III( CRC undergoing radical resection at Shanghai Ruijin Hospital from January 2008 to December 2010 were analyzed retrospectively. NLR was calculated from neutrophil and lymphocyte counts on routine blood tests prior to surgery. The optimal cutoff value of NLR for predicting 5-year overall survival (OS) was determined through receiver operating characteristic (ROC) curve analysis. According to the cut-off value, patients were divided into high NLR and low NLR groups. Clinicopathological characteristics and prognosis were compared between two groups. Univariate and multivariate analyses were performed with Cox proportional hazards model to evaluate the impact of clinical factors on prognosis.
A total of 396 male and 288 female patients were included in the study, with a median age of 62 years(range 21-92).Among these patients, 335 had rectal cancers and 349 had colonic cancers; 328 were TNM stage II( and 356 were stage III(. The end of follow-up was January 2016. ROC curve showed that the optimal cut-off value of NLR was 3.0, then patients were divided into low NLR group (NLR≤3.0, n=481) and high NLR group (NLR>3.0, n=203). Compared with low NLR group, the high NLR group was more likely to be older (median 64 vs. 61, t=-2.412, P=0.016), presented higher ratio of colonic cancer [66.0%(134/203) vs. 44.7%(215/481), χ=25.945, P=0.000] and stage III( tumor [60.1%(122/203) vs. 48.6%(234/481), χ=7.499, P=0.007], but lower ratio of first-degree relative cancer history [8.9%(18/203) vs. 15.6%(75/481); χ=5.496, P=0.020]. However, no significant differences were observed between two groups in gender, smoking and drinking history, tumor differentiation grade, vessel invasion and nerve invasion (all P>0.05). The median follow-up time was 67 months (range 3-92), and the 5-year OS rates of high NLR and low NLR group were 59.6% and 73.2% respectively, with significant difference (P=0.001). Cox multivariate analysis revealed that age >65 years (HR=2.07, 95%CI=1.59-2.70, P=0.000), no first-degree relative cancer history (HR=2.01, 95%CI=1.23-3.28, P=0.005), poor differentiation grade (HR=1.65, 95%CI=1.26-2.15, P=0.000), positive vessel or nerve invasion (HR=1.92, 95%CI=1.35-2.71, P=0.000), high TNM stage(HR=2.10, 95%CI=1.59-2.77, P=0.000) and preoperative NLR>3.0(HR=1.51, 95%CI=1.14-2.00, P=0.004) were independent risk factors of prognosis for patients with LACRC.
Preoperative NLR can influence the prognosis of patients with LACRC receiving radical surgery. High NLR is associated with poor prognosis.
探讨中性粒细胞与淋巴细胞比值（NLR）对局部晚期结直肠癌（LACRC）患者预后的影响。
回顾性分析2008年1月至2010年12月在上海瑞金医院接受根治性手术的684例II（-III（期结直肠癌患者的临床病理资料。术前通过常规血常规检查中的中性粒细胞和淋巴细胞计数计算NLR。通过受试者工作特征（ROC）曲线分析确定预测5年总生存（OS）的NLR最佳临界值。根据该临界值，将患者分为高NLR组和低NLR组。比较两组的临床病理特征和预后。采用Cox比例风险模型进行单因素和多因素分析，以评估临床因素对预后的影响。
本研究共纳入396例男性和288例女性患者，中位年龄为62岁（范围21-92岁）。这些患者中，335例为直肠癌，349例为结肠癌；328例为TNM II（期，356例为III（期。随访截止至2016年1月。ROC曲线显示，NLR的最佳临界值为3.0，然后将患者分为低NLR组（NLR≤3.0，n=481）和高NLR组（NLR>3.0，n=203）。与低NLR组相比，高NLR组患者年龄更大（中位年龄64岁对61岁，t=-2.412，P=0.016），结肠癌比例更高[66.0%（134/203）对44.7%（215/481），χ=25.945，P=0.000]，III（期肿瘤比例更高[60.1%（122/203）对48.6%（234/481），χ=7.499，P=0.007]，但一级亲属癌症病史比例更低[8.9%（18/203）对15.6%（75/481）；χ=5.496，P=0.020]。然而，两组在性别、吸烟和饮酒史、肿瘤分化程度、血管侵犯和神经侵犯方面均无显著差异（均P>0.05）。中位随访时间为67个月（范围3-92个月），高NLR组和低NLR组的5年OS率分别为59.6%和73.2%，差异有统计学意义（P=0.001）。Cox多因素分析显示，年龄>65岁（HR=2.07，95%CI=1.59-2.70，P=0.000）、无一级亲属癌症病史（HR=2.01，95%CI=1.23-3.28，P=0.005）、分化程度差（HR=1.65，95%CI=1.26-2.15，P=0.000）、血管或神经侵犯阳性（HR=1.92，95%CI=1.35-2.71，P=0.000）、高TNM分期（HR=2.10，95%CI=1.59-2.77，P=0.000）和术前NLR>3.0（HR=1.51，95%CI=
