Department of Surgery, Dankook University Hospital, Chungnam, South Korea.
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
Int J Colorectal Dis. 2020 Jul;35(7):1211-1219. doi: 10.1007/s00384-020-03591-1. Epub 2020 Apr 18.
To date, there have been many studies on postoperative complications and oncologic outcomes, but the findings remain controversial. The purpose of the study was to determine the prognostic value of serum inflammatory markers as pretreatment in curatively resected colorectal cancer. The effects of serum inflammatory marker levels on postoperative morbidity were also examined.
Prospectively collected data from 1590 patients with primary sporadic colorectal adenocarcinoma who underwent curative resection between September 2012 and December 2013 at our institution were retrospectively analyzed. White blood cell count (× 10/mcl), neutrophil/lymphocyte ratio, C-reactive protein, erythrocyte sedimentation rate (ESR), and Glasgow prognostic score (GPS) were evaluated. GPS was determined as follows: GPS of 2, elevated CRP level (> 1.0 mg/dl) and hypoalbuminemia (< 3.5 g/dl); GPS of 1, elevated CRP or hypoalbuminemia; and GPS of 0, neither elevated CRP nor hypoalbuminemia.
The median follow-up period for the 1590 patients was 59 months. The overall postoperative morbidity rate was 24.8%. In multivariate analysis, female sex (P = 0.006), rectal cancer other than colon cancer (P < 0.001), CEA level > 5 ng/ml (P < 0.001), ESR > 27 mm/h (P = 0.014), and a GPS of 1 or 2 (P < 0.001) were independent risk predictors for morbidity. A GPS of 1 or 2 (P < 0.001) and postoperative morbidity (P < 0.001) significantly affected both overall survival and disease-free survival in multivariate analyses.
A GPS of 1 or 2 is a significant risk factor for postoperative morbidity and a prognostic factor for long-term survival.
迄今为止，已有许多关于术后并发症和肿瘤学结果的研究，但研究结果仍存在争议。本研究旨在确定血清炎症标志物作为可切除结直肠癌患者术前的预后价值。还研究了血清炎症标志物水平对术后发病率的影响。
回顾性分析了 2012 年 9 月至 2013 年 12 月我院收治的 1590 例原发性散发性结直肠腺癌患者的前瞻性收集数据。评估了白细胞计数（×10/mcl）、中性粒细胞/淋巴细胞比值、C 反应蛋白、红细胞沉降率（ESR）和格拉斯哥预后评分（GPS）。GPS 如下确定：GPS 为 2，CRP 水平升高（>1.0mg/dl）和低白蛋白血症（<3.5g/dl）；GPS 为 1，CRP 升高或低白蛋白血症；GPS 为 0，既不升高 CRP 也不低白蛋白血症。
1590 例患者的中位随访时间为 59 个月。总术后发病率为 24.8%。多因素分析显示，女性（P=0.006）、直肠癌而非结肠癌（P<0.001）、CEA 水平>5ng/ml（P<0.001）、ESR>27mm/h（P=0.014）和 GPS 为 1 或 2（P<0.001）是发病率的独立危险因素。GPS 为 1 或 2（P<0.001）和术后发病率（P<0.001）在多因素分析中均显著影响总生存和无病生存。
GPS 为 1 或 2 是术后发病率的重要危险因素，也是长期生存的预后因素。
