McCluney Simon J, Giakoustidis Alexandros, Segler Angela, Bissel Juliane, Valente Roberto, Hutchins Robert R, Abraham Ajit T, Bhattacharya Satyajit, Kocher Hemant M
Barts and The London HPB Centre, Department of Surgery, The Royal London Hospital, Barts Health NHS Trust, Whitechapel, London, UK.
Barts Cancer Institute-Cancer Research UK Centre of Excellence, Queen Mary, UK.
J Surg Oncol. 2018 Apr;117(5):1058-1065. doi: 10.1002/jso.24996. Epub 2018 Feb 15.
Approximately 30-50% of patients with colorectal cancer develop liver metastasis for which liver resection is the only hope for potential cure. However, hepatic resection is associated with considerable morbidity. The aim was to detect early complications by utilising the neutrophil: lymphocyte ratio (NLR).
We performed a retrospective cohort study of patients undergoing hepatic resection at a single institution between 2008 and 2016. Baseline demographics and complications within 30 days following surgery were recorded, with blood tests measured until day 7. Statistical analysis was performed using Mann Whitney and ROC analysis.
One hundred eighty-eight operations were included. 47.3% had an associated complication, of which 31.46% were major. The median NLR was 6.31 across the cohort, 5.44 for uncomplicated procedures, 7.0 for complications and 10.65 in major complications. Median NLR was the best parameter for detecting major complications versus minor complications (AUC 0.74) as opposed to lymphocytes (AUC 0.65), neutrophils (AUC 0.60), and CRP (AUC 0.60). The diagnostic ability of NLR increased further when predicting major complications versus an uncomplicated recovery (AUC 0.78), and it was the only significant parameter in the early post-operative period on days 2, 3, and 4 (AUC 0.70, 0.72, and 0.75).
The NLR may have a role in predicting complications following hepatic resection for CLM, and with earlier detection, potentially improving outcomes.
约30%-50%的结直肠癌患者会发生肝转移，肝切除是实现潜在治愈的唯一希望。然而，肝切除会带来相当高的发病率。本研究旨在通过利用中性粒细胞与淋巴细胞比值（NLR）来检测早期并发症。
我们对2008年至2016年间在单一机构接受肝切除的患者进行了一项回顾性队列研究。记录了患者的基线人口统计学数据和术后30天内的并发症情况，并在术后第7天进行血液检查。采用Mann Whitney检验和ROC分析进行统计分析。
共纳入188例手术。47.3%的患者出现相关并发症，其中31.46%为严重并发症。整个队列的NLR中位数为6.31，无并发症手术患者的NLR中位数为5.44，有并发症患者的NLR中位数为7.0，严重并发症患者的NLR中位数为10.65。与淋巴细胞（AUC 0.65）、中性粒细胞（AUC 0.60）和CRP（AUC 0.60）相比，NLR中位数是检测严重并发症与轻微并发症的最佳参数（AUC 0.74）。在预测严重并发症与无并发症恢复情况时，NLR的诊断能力进一步提高（AUC 0.78），并且在术后第2、3和4天的早期术后阶段，它是唯一具有显著意义的参数（AUC 0.70、0.72和0.75）。
NLR可能在预测结直肠癌肝转移肝切除术后的并发症方面发挥作用，通过早期检测，有可能改善预后。
