Department of Colorectal Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 1040045, Japan.
Division of Frontier Surgery, The Institute of Medical Science, The University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, 1088639, Japan.
Br J Cancer. 2021 Mar;124(5):933-941. doi: 10.1038/s41416-020-01189-6. Epub 2020 Dec 1.
BACKGROUND: Recent evidence suggests that both preoperative and postoperative inflammation-based prognostic markers are useful for predicting the survival of colorectal cancer (CRC) patients. However, associations between longitudinal changes in inflammation-based prognostic markers and prognosis are controversial. METHODS: The subjects of this study were 568 patients with stage III CRC between 2008 and 2014. Preoperative and postoperative neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), C-reactive protein/albumin ratio (CAR) and lymphocyte-to-C-reactive protein ratio (LCR) were calculated to assess the inflammatory state of subjects. Subjects were stratified into three groups for each marker: preoperatively low inflammatory state (normal group), preoperatively high but postoperatively low inflammatory state (normalised group) and persistently high inflammatory state (elevated group). Multivariable analyses for overall survival (OS) and recurrence-free survival (RFS) were performed to adjust for well-established clinicopathologic factors. RESULTS: For all assessed markers, the normalised group had a significantly better prognosis than the elevated group and a similar prognosis as the normal group for both OS and RFS. CONCLUSIONS: Postoperative, but not preoperative, inflammation-based prognostic markers more accurately predict OS and RFS in patients with stage III CRC.
背景:最近的证据表明,术前和术后炎症相关预后标志物均有助于预测结直肠癌(CRC)患者的生存情况。然而,炎症相关预后标志物的纵向变化与预后之间的关联仍存在争议。
方法:本研究的对象为 2008 年至 2014 年间的 568 例 III 期 CRC 患者。计算术前和术后中性粒细胞与淋巴细胞比值(NLR)、淋巴细胞与单核细胞比值(LMR)、C 反应蛋白/白蛋白比值(CAR)和淋巴细胞与 C 反应蛋白比值(LCR),以评估受试者的炎症状态。根据每个标志物将受试者分为三组:术前低炎症状态(正常组)、术前高但术后低炎症状态(正常化组)和持续高炎症状态(升高组)。进行多变量分析以调整包括既定临床病理因素在内的总生存期(OS)和无复发生存期(RFS)。
结果:对于所有评估的标志物,正常化组的 OS 和 RFS 预后均明显优于升高组,与正常组相似。
结论:术后而非术前的炎症相关预后标志物更能准确预测 III 期 CRC 患者的 OS 和 RFS。
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