Nagai Hidemasa, Yuasa Norihiro, Takeuchi Eiji, Miyake Hideo, Yoshioka Yuichiro, Miyata Kanji
Department of Gastrointestinal Surgery, Japanese Red Cross Nagoya First Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan.
Surg Today. 2018 Feb;48(2):186-194. doi: 10.1007/s00595-017-1575-x. Epub 2017 Aug 9.
The aim of the present study was to identify the factors investigated during routine blood examinations which can predict the disease outcome independent of the tumor stage.
Data from 1174 patients with stage I, II, and III CRC who underwent R0 resection were included. We investigated the correlations between the preoperative routine blood examination data, and clinicopathological factors, and disease-free survival (DFS) using univariate and multivariate analyses.
The univariate analysis showed that tumor location, tumor stage, CRP, serum albumin, creatine kinase, neutrophil-to-lymphocyte ratio, red blood cell count, mean corpuscular volume (MCV), and the administration of postoperative adjuvant chemotherapy were significantly correlated with the DFS. The multivariate analysis of the factors associated with the DFS showed that stage and MCV were significant factors; an MCV of <80 fL was associated with a superior DFS in comparison to an MCV of 80-100 fL (hazard ratio: 0.31, 95% confidence interval: 0.13-0.61, p = 0.0003). The DFS in patients with an MCV of <80 fL was superior to that in patients with an MCV of ≥80 fL, irrespective of whether the patients underwent postoperative adjuvant chemotherapy.
MCV was a prognostic factor for the DFS, independent of the tumor stage, in CRC patients who underwent R0 resection.
本研究旨在确定在常规血液检查中所研究的、能够独立于肿瘤分期预测疾病转归的因素。
纳入1174例行R0切除的I、II和III期结直肠癌患者的数据。我们采用单因素和多因素分析研究术前常规血液检查数据、临床病理因素与无病生存期（DFS）之间的相关性。
单因素分析显示，肿瘤位置、肿瘤分期、CRP、血清白蛋白、肌酸激酶、中性粒细胞与淋巴细胞比值、红细胞计数、平均红细胞体积（MCV）以及术后辅助化疗的应用与DFS显著相关。DFS相关因素的多因素分析显示，分期和MCV是显著因素；与MCV为80 - 100 fL相比，MCV < 80 fL与更好的DFS相关（风险比：0.31，95%置信区间：0.13 - 0.61，p = 0.0003）。无论患者是否接受术后辅助化疗，MCV < 80 fL患者的DFS均优于MCV≥80 fL的患者。
在接受R0切除的结直肠癌患者中，MCV是独立于肿瘤分期的DFS预后因素。
