Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan.
Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan.
J Surg Res. 2021 Feb;258:414-421. doi: 10.1016/j.jss.2020.08.059. Epub 2020 Oct 24.
The preoperative systemic inflammation has been reported to predict tumor recurrence and survival in various cancers, including colorectal liver metastases (CRLM). However, more sensitive biomarker is required to improve perioperative management of CRLM. Therefore, we developed a novel indicator; C-reactive protein-to-lymphocyte ratio (CLR). The aim of this study is to evaluate the prognostic significance of CLR in patients with CRLM after hepatic resection.
The study comprised 197 patients who had undergone hepatic resection for CRLM between January 2000 and December 2018. We retrospectively investigated the relation between CLR and disease-free survival and overall survival after hepatic resection and compared their prognostic significance with that of the C-reactive protein-to-albumin ratio and neutrophil-to-lymphocyte ratio.
Optimal cutoff level of the CLR by receiver operating characteristics analysis was 62.8 × 10. By multivariate analysis, CLR was an independent predictor of disease-free survival [hazard ratio (HR): 1.463, 95% confidence interval (CI): 1.003-2.135, P = 0.048), whereas lymph node metastases>4 (HR: 1.804, 95% CI: 1.100-2.958, P = 0.019) and CLR (HR: 1.656, 95% CI: 1.007-2.724, P = 0.047) were independent predictors of overall survival, while the C-reactive protein-to-albumin ratio and neutrophil-to-lymphocyte ratio were not.
CLR may be an independent and significant indicator of poor long-term outcomes in patients with CRLM after hepatic resection.
术前全身炎症反应已被报道可预测多种癌症（包括结直肠癌肝转移）的肿瘤复发和生存情况。然而，需要更敏感的生物标志物来改善结直肠癌肝转移患者的围手术期管理。因此，我们开发了一种新的指标：C 反应蛋白与淋巴细胞比值（CLR）。本研究旨在评估 CLR 对接受肝切除治疗的结直肠癌肝转移患者的预后意义。
本研究纳入了 197 例 2000 年 1 月至 2018 年 12 月期间因结直肠癌肝转移接受肝切除术的患者。我们回顾性调查了 CLR 与肝切除术后无病生存和总生存之间的关系，并将其与 C 反应蛋白与白蛋白比值和中性粒细胞与淋巴细胞比值的预后意义进行了比较。
通过接受者操作特征分析得出 CLR 的最佳截断值为 62.8×10。多因素分析显示，CLR 是无病生存的独立预测因子[风险比（HR）：1.463，95%置信区间（CI）：1.003-2.135，P=0.048），而淋巴结转移>4（HR：1.804，95%CI：1.100-2.958，P=0.019）和 CLR（HR：1.656，95%CI：1.007-2.724，P=0.047）是总生存的独立预测因子，而 C 反应蛋白与白蛋白比值和中性粒细胞与淋巴细胞比值则不是。
CLR 可能是结直肠癌肝转移患者肝切除术后长期预后不良的独立且重要的指标。
