Division of Colorectal Surgery, University Surgical Cluster, National University Health System, Singapore.
Division of Colorectal Surgery, University Surgical Cluster, National University Health System, Singapore; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
J Surg Res. 2021 Mar;259:71-78. doi: 10.1016/j.jss.2020.11.027. Epub 2020 Dec 3.
A preoperative marker for morbidity in patients with colorectal cancer would help to risk stratify patients and allow for timely intervention to avert poor outcomes. We conducted this study to evaluate preoperative lymphocyte-white blood cell ratio (LWR) as a marker of postoperative morbidity.
A prospective cohort of patients who underwent elective surgery for colorectal cancer was reviewed. Three morbidity-related outcomes were described-overall morbidity, multiple morbidities, and severe morbidity, defined as Clavien-Dindo Class ≥3. Univariable and multivariable analyses of presurgical predictors of these three outcomes were performed. Preoperative variables included hemoglobin levels, neoadjuvant therapy, albumin levels, white blood cell count, lymphocyte count, LWR, neutrophil-lymphocyte ratio, and prognostic nutritional index.
Of 177 patients, 31.6% (56/177) suffered at least one morbidity, 15.3% (27/177) had multiple morbidities, 7.9% (14/177) suffered severe morbidity. On multivariate analysis, only LWR <0.180 (odds ratio [OR] 2.53, 95% confidence interval [CI] 1.15-5.55) and neoadjuvant therapy (OR 2.49, 95% CI 1.16-5.24) were associated with overall morbidity. For multiple morbidities and severe morbidity, only LWR <0.180 was significantly associated on multivariate analysis with an OR of 2.92 (95% CI 1.19-7.13) and 4.62 (95% CI 1.45-14.73), respectively.
LWR is a preoperative marker which can be conveniently applied using standard preoperative blood tests. LWR is an independent risk factor for overall morbidity, multiple morbidities, as well as severe morbidity when used with a cut-off of LWR<1.80.
结直肠癌患者术前的发病率标志物有助于对患者进行风险分层，并及时进行干预以避免不良结局。我们进行这项研究旨在评估术前淋巴细胞-白细胞比值（LWR）作为术后发病率的标志物。
回顾性分析了接受择期结直肠癌手术的患者前瞻性队列。描述了三种与发病率相关的结果-总体发病率、多种发病率和严重发病率，定义为 Clavien-Dindo 分级≥3。对这三种结果的术前预测指标进行了单变量和多变量分析。术前变量包括血红蛋白水平、新辅助治疗、白蛋白水平、白细胞计数、淋巴细胞计数、LWR、中性粒细胞-淋巴细胞比值和预后营养指数。
在 177 例患者中，31.6%（56/177）至少发生了一种发病率，15.3%（27/177）发生了多种发病率，7.9%（14/177）发生了严重发病率。多变量分析显示，只有 LWR<0.180（比值比[OR]2.53，95%置信区间[CI]1.15-5.55）和新辅助治疗（OR2.49，95%CI1.16-5.24）与总体发病率相关。对于多种发病率和严重发病率，只有 LWR<0.180 在多变量分析中与 OR 分别为 2.92（95%CI1.19-7.13）和 4.62（95%CI1.45-14.73）显著相关。
LWR 是一种术前标志物，可使用标准术前血液检查方便地应用。LWR 是总体发病率、多种发病率以及严重发病率的独立危险因素，当使用 LWR<1.80 的截断值时，LWR 是一个独立危险因素。
