循环CEA-dNLR评分可预测转移性胆囊癌患者的临床结局。
Circulating CEA-dNLR score predicts clinical outcome of metastatic gallbladder cancer patient.
作者信息
Du Jing-Hui, Lu Jun
机构信息
Department of Clinical Laboratory, The First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Nankai, Tianjin, China.
Department of Clinical Laboratory, Longyan People Hospital, Longyan, China.
出版信息
J Clin Lab Anal. 2019 Feb;33(2):e22684. doi: 10.1002/jcla.22684. Epub 2018 Nov 21.
BACKGROUND
Cancer-related inflammation promotes gallbladder tumorigenesis and metastasis of gallbladder cancer (mGBC). The levels of circulating inflammatory-related cell and protein as well as the ratios of them may imply the severity of chronic inflammation in GBC patients, and all of them are candidate prognostic biomarkers for mGBC.
MATERIALS AND METHODS
In our study, pre-treatment circulating immune cell, fibrinogen (Fib), albumin (Alb), and pre-albumin (pAlb) were detected in 220 mGBC patients, and we calculated neutrophil-to-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (dNLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), Alb-to-Fib ratio (AFR), and Fib-to-pAlb ratio (FPR) replying on the detection. Three years' follow-up was carried out in those patients, and we investigated the possible associations between those biomarkers and three years' overall survival (OS) of these patients using X-tile software, Kaplan-Meier curve, Cox regression, and time-dependent receiver operating characteristics (ROC).
RESULTS
Our results showed that OS of the patients with high pAlb and LMR was significantly superior to the cases with the low biomarkers, respectively. However, survival of the cases with high CEA, dNLR, and FPR was significantly inferior to the patients with low levels of those biomarkers. Area under the curve (AUC) of time-dependent ROC of CEA and dNLR was higher than pAlb, LMR, and FPR, respectively. Additionally, higher CEA-dNLR score (adjusted HR = 3.09, 95% CI = 1.01-4.51 for the score one; adjusted HR = 4.99, 95% CI = 2.32-7.21 for the score two) was significantly associated with reduced survival of the patients, and AUC of the score for predicting clinical outcome of mGBC patients was 0.756, and it was significantly higher than the single CEA and dNLR, respectively.
CONCLUSION
Our findings implied that pretreatment CEA-dNLR score was superior to the other biomarkers to predict OS of mGBC patients, and it was an independent prognostic factor for the disease.
背景
癌症相关炎症促进胆囊肿瘤发生及胆囊癌转移（mGBC）。循环炎症相关细胞和蛋白水平及其比值可能提示GBC患者慢性炎症的严重程度，且它们均为mGBC的候选预后生物标志物。
材料与方法
在我们的研究中，检测了220例mGBC患者治疗前的循环免疫细胞、纤维蛋白原（Fib）、白蛋白（Alb）和前白蛋白（pAlb），并根据检测结果计算中性粒细胞与淋巴细胞比值（NLR）、衍生中性粒细胞与淋巴细胞比值（dNLR）、淋巴细胞与单核细胞比值（LMR）、血小板与淋巴细胞比值（PLR）、Alb与Fib比值（AFR）以及Fib与pAlb比值（FPR）。对这些患者进行了三年随访，我们使用X-tile软件、Kaplan-Meier曲线、Cox回归和时间依赖性受试者工作特征（ROC）研究了这些生物标志物与这些患者三年总生存期（OS）之间的可能关联。
结果
我们的结果显示，pAlb和LMR高的患者的OS分别显著优于生物标志物低的患者。然而，CEA、dNLR和FPR高的患者的生存期显著低于这些生物标志物水平低的患者。CEA和dNLR的时间依赖性ROC曲线下面积（AUC）分别高于pAlb、LMR和FPR。此外，较高的CEA-dNLR评分（评分一的调整后HR = 3.09，95%CI = 1.01 - 4.51；评分二的调整后HR = 4.99，95%CI = 2.32 - 7.21）与患者生存期缩短显著相关，预测mGBC患者临床结局的评分的AUC为0.756，且分别显著高于单一的CEA和dNLR。
结论
我们的研究结果表明，治疗前CEA-dNLR评分在预测mGBC患者的OS方面优于其他生物标志物，且是该疾病的独立预后因素。
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