Department of Colorectal Surgery, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, Fujian, People's Republic of China.
World J Surg. 2020 Jun;44(6):1975-1984. doi: 10.1007/s00268-020-05407-3.
Coagulation and inflammation play important roles in tumor progression. This study aimed to explore the prognostic impact of combined analysis of fibrinogen and neutrophil-to-lymphocyte (NLR) ratio (F-NLR score) in locally advanced rectal cancer (LARC) receiving preoperative chemoradiotherapy (pCRT) and radical surgery.
Totally 317 patients were included. X-tile analysis was used to determine the optimal cutoff values of preoperative fibrinogen and NLR. F-NLR scores were defined as 2 (both high fibrinogen and NLR), 1 (one of these abnormalities), or 0 (neither abnormality). Time-dependent ROC analysis was used to evaluate the predictive accuracy of fibrinogen, NLR, and F-NLR score. Cox regression analysis was performed to evaluate the prognostic impact of the F-NLR score. A predictive nomogram for disease-free survival (DFS) was developed and validated internally.
One hundred and seventeen (36.9%), 156 (49.2%), and 44 (13.9%) patients had F-NLR score of 0, 1, and 2, respectively. Higher F-NLR score was associated with poorly differentiated tumors, deeper tumor invasion, lymph node metastasis, and more advanced pTNM stage (all P < 0.05). The 5-year OS rates in the F-NLR 0, 1, and 2 groups were 93.6%, 87.3%, and 68.4%, respectively (P < 0.001), while the 5-year DFS rates were 91.8%, 76.8%, and 56.1%, respectively (P < 0.001). Cox regression analysis demonstrated that F-NLR score (F-NLR 1, HR = 2.021, P = 0.046; F-NLR 2, HR = 3.356, P = 0.002), pTNM stage III (HR = 3.109, P = 0.009), and circumferential resection margin (CRM) involvement (HR = 3.120, P = 0.021) were independently associated with DFS. A nomogram for DFS was developed (C-index 0.708).
F-NLR score is a promising predictor for disease recurrence in LARC patients after pCRT.
凝血和炎症在肿瘤进展中起着重要作用。本研究旨在探讨术前放化疗（pCRT）和根治性手术后联合分析纤维蛋白原和中性粒细胞与淋巴细胞比值（NLR）（F-NLR 评分）对局部晚期直肠癌（LARC）患者预后的影响。
共纳入 317 例患者。X-tile 分析确定术前纤维蛋白原和 NLR 的最佳截断值。F-NLR 评分定义为 2（纤维蛋白原和 NLR 均高）、1（两者之一异常）或 0（均无异常）。时间依赖性 ROC 分析用于评估纤维蛋白原、NLR 和 F-NLR 评分的预测准确性。Cox 回归分析评估 F-NLR 评分的预后影响。开发并内部验证了无病生存（DFS）的预测列线图。
117（36.9%）、156（49.2%）和 44（13.9%）例患者的 F-NLR 评分分别为 0、1 和 2。较高的 F-NLR 评分与低分化肿瘤、更深的肿瘤侵袭、淋巴结转移和更晚期的 pTNM 分期有关（均 P<0.05）。F-NLR 0、1 和 2 组的 5 年 OS 率分别为 93.6%、87.3%和 68.4%（P<0.001），5 年 DFS 率分别为 91.8%、76.8%和 56.1%（P<0.001）。Cox 回归分析表明，F-NLR 评分（F-NLR 1，HR=2.021，P=0.046；F-NLR 2，HR=3.356，P=0.002）、pTNM 分期 III 期（HR=3.109，P=0.009）和环周切缘（CRM）受累（HR=3.120，P=0.021）与 DFS 独立相关。建立了 DFS 列线图（C 指数 0.708）。
F-NLR 评分是预测 LARC 患者 pCRT 后疾病复发的有前途的指标。
