Lin Shi-Qi, Xie Hai-Lun, Ge Yi-Zhong, Ruan Guo-Tian, Zhang Qi, Song Meng-Meng, Zhang He-Yang, Zhang Xi, Li Xiang-Rui, Tang Meng, Shen Xian, Song Chun-Hua, Li Wei, Shi Han-Ping
1Department of Surgery, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.
Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
Front Oncol. 2022 Oct 24;12:896160. doi: 10.3389/fonc.2022.896160. eCollection 2022.
Systemic inflammation and water composition are important factors affecting cancer prognosis. This study aimed to explore the association between the neutrophil-to-lymphocyte ratio (NLR) and intracellular water/total body water (ICW/TBW) ratio and overall survival (OS) in colorectal cancer (CRC).
This multicenter, prospective cohort included 628 patients with CRC between June 2012 and December 2019. The association between the covariates and OS was assessed using a Cox proportional hazards model and restricted cubic spline models. Concordance index (C-index), which integrated discriminant improvement (IDI) index and continuous net reclassification index, (cNRI) was used to compare the predictive ability of the markers.
The optimal cutoff values for the NLR and ICW/TBW ratio were 2.42 and 0.61, respectively. The NLR was negatively associated with OS, while the ICW/TBW ratio was positively correlated with OS. NLR ≥2.42 and ICW/TBW ratio <0.61 were both independent poor prognostic factors (hazard ratio [HR]: 2.04, 95% confidence interval [CI]: 1.44-2.88 and HR: 1.45, 95% CI: 1.04-2.02, respectively). Subsequently, we combined the two factors to construct an inflammation-water score (IWS). Patients with IWS (2, ≥1) had worse OS (HR: 2.86 and 95% CI: 1.77-4.63; HR: 1.74 and 95% CI 1.17-2.57, respectively) than those without one. Compared to its component factors, IWS score showed better predictive ability for C-index, IDI index, and cNRI.
A high NLR and a low ICW/TBW ratio were independent risk factors for poor prognosis in patients with CRC. The combination of the two factors can provide a better prognostic prediction effect.
全身炎症和水分组成是影响癌症预后的重要因素。本研究旨在探讨中性粒细胞与淋巴细胞比值（NLR）和细胞内水/总体水（ICW/TBW）比值与结直肠癌（CRC）患者总生存期（OS）之间的关联。
这项多中心前瞻性队列研究纳入了2012年6月至2019年12月期间的628例CRC患者。使用Cox比例风险模型和限制性立方样条模型评估协变量与OS之间的关联。采用综合判别改善（IDI）指数和连续净重新分类指数（cNRI）的一致性指数（C-index）来比较各标志物的预测能力。
NLR和ICW/TBW比值的最佳截断值分别为2.42和0.61。NLR与OS呈负相关，而ICW/TBW比值与OS呈正相关。NLR≥2.42和ICW/TBW比值<0.61均为独立的不良预后因素（风险比[HR]：2.04，95%置信区间[CI]：1.44 - 2.88；HR：1.45，95% CI：1.04 - 2.02）。随后，我们将这两个因素结合构建了炎症 - 水评分（IWS）。IWS（2，≥1）的患者的OS比无此情况的患者更差（HR：2.86，95% CI：1.77 - 4.63；HR：1.74，95% CI 1.17 - 2.57）。与各组成因素相比，IWS评分在C-index、IDI指数和cNRI方面显示出更好的预测能力。
高NLR和低ICW/TBW比值是CRC患者预后不良的独立危险因素。这两个因素的结合可提供更好的预后预测效果。
