Department of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
Department of Genomic Medicine, Division of Reparative Medicine, Institute of Life Sciences, Mie University Graduate School of Medicine, Tsu, Mie, Japan.
Surg Today. 2021 Dec;51(12):1906-1917. doi: 10.1007/s00595-021-02291-9. Epub 2021 May 5.
Systemic inflammatory response influences cancer development and perioperative surgical stress can affect the survival of patients with colorectal cancer (CRC). We developed a system to cumulatively assess perioperative inflammatory response and compare the prognostic value of various cumulative inflammatory and nutritional markers in patients with CRC.
We assessed perioperative cumulative markers using the trapezoidal area method in 307 patients who underwent surgery for CRC and analyzed the results statistically.
The cumulative lymphocyte to C-reactive protein (CRP) ratio (LCR) predicted survival more accurately than other well-established markers (sensitivity: 80.0%, specificity: 69.3%; area under the curve (AUC): 0.779; P < 0.001). A low cumulative LCR was correlated with factors associated with disease development, including undifferentiated histology, advanced T stage, lymph node metastasis, distant metastasis, and advanced TNM stage classification. A decreased cumulative LCR was an independent prognostic factor for both overall survival (OS) (Hazard Ratio (HR):5.21, 95% confidence interval [CI] 2.42-11.2; P < 0.0001) and disease-free survival (DFS) (HR: 1.88, 95% CI 1.07-3.31; P = 0.02), and its prognostic significance was verified in a different clinical setting. The cumulative LCR was correlated negatively with the intraoperative bleeding volume (P < 0.0001, R = 0.4). Combined analysis of cumulative and preoperative LCR could help stratify risk for the oncological outcomes of CRC patients.
The findings of this study demonstrate the value of the cumulative LCR in the postoperative management of patients with CRC.
全身性炎症反应会影响癌症的发生，围手术期的外科应激可能会影响结直肠癌（CRC）患者的生存。我们开发了一种系统来累积评估围手术期炎症反应，并比较 CRC 患者各种累积炎症和营养标志物的预后价值。
我们使用梯形面积法评估了 307 例接受 CRC 手术的患者的围手术期累积标志物，并进行了统计学分析。
累积淋巴细胞与 C 反应蛋白（CRP）比值（LCR）比其他公认的标志物更能准确预测生存（敏感性：80.0%，特异性：69.3%；曲线下面积（AUC）：0.779；P < 0.001）。低累积 LCR 与与疾病发展相关的因素相关，包括未分化组织学、T 期较晚、淋巴结转移、远处转移和较晚的 TNM 分期。累积 LCR 降低是总生存期（OS）（风险比（HR）：5.21，95%置信区间[CI]：2.42-11.2；P < 0.0001）和无病生存期（DFS）（HR：1.88，95% CI：1.07-3.31；P = 0.02）的独立预后因素，并且在不同的临床环境中验证了其预后意义。累积 LCR 与术中出血量呈负相关（P < 0.0001，R = 0.4）。累积和术前 LCR 的联合分析有助于分层 CRC 患者的肿瘤学结局风险。
本研究的结果表明，累积 LCR 在 CRC 患者的术后管理中具有价值。
