Turri Giulia, Caligola Simone, Ugel Stefano, Conti Cristian, Zenuni Silvia, Barresi Valeria, Ruzzenente Andrea, Lippi Giuseppe, Scarpa Aldo, Bronte Vincenzo, Guglielmi Alfredo, Pedrazzani Corrado
Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy.
Istituto Oncologico Veneto IRCCS, Padova, Italy.
Front Oncol. 2023 Jun 5;13:1148197. doi: 10.3389/fonc.2023.1148197. eCollection 2023.
Emerging evidence is pointing towards a relevant role of immunity in cancer development. Alterations in leukocytes count and neutrophil-to-lymphocyte ratio (NLR) at diagnosis of colorectal cancer (CRC) seems to predict poor prognosis, but no data is available for the pre-diagnostic values.
Retrospective analysis of patients who underwent surgery for CRC at our center (2005 - 2020). 334 patients with a complete blood count dating at least 24 months prior to diagnosis were included. Changes in pre-diagnosis values of leukocytes (Pre-Leu), lymphocytes (Pre-Lymph), neutrophils (Pre-Neut), and NLR (Pre-NLR) and their correlation with overall- (OS) and cancer-related survival (CRS) were analyzed.
Pre-Leu, Pre-Neut and Pre-NLR showed an increasing trend approaching the date of diagnosis, while Pre-Lymph tended to decrease. The parameters were tested for associations with survival after surgery through multivariable analysis. After adjusting for potential confounding factors, Pre-Leu, Pre-Neut, Pre-Lymph and Pre-NLR resulted independent prognostic factors for OS and CRS. On sub-group analysis considering the interval between blood sampling and surgery, higher Pre-Leu, Pre-Neut, and Pre-NLR and lower Pre-Lymph were associated with worse CRS, and the effect was more evident when blood samples were closer to surgery.
To our knowledge, this is the first study showing a significant correlation between pre-diagnosis immune profile and prognosis in CRC.
新出现的证据表明免疫在癌症发展中具有重要作用。结直肠癌（CRC）诊断时白细胞计数和中性粒细胞与淋巴细胞比值（NLR）的改变似乎预示着预后不良，但尚无诊断前值的数据。
对在我们中心接受CRC手术的患者（2005 - 2020年）进行回顾性分析。纳入334例在诊断前至少24个月有全血细胞计数的患者。分析诊断前白细胞（Pre-Leu）、淋巴细胞（Pre-Lymph）、中性粒细胞（Pre-Neut）和NLR（Pre-NLR）值的变化及其与总生存期（OS）和癌症相关生存期（CRS）的相关性。
Pre-Leu、Pre-Neut和Pre-NLR在接近诊断日期时呈上升趋势，而Pre-Lymph则呈下降趋势。通过多变量分析测试这些参数与术后生存期的关联。在调整潜在混杂因素后，Pre-Leu、Pre-Neut、Pre-Lymph和Pre-NLR成为OS和CRS的独立预后因素。在考虑采血与手术间隔的亚组分析中，较高的Pre-Leu、Pre-Neut和Pre-NLR以及较低的Pre-Lymph与较差的CRS相关，当血样更接近手术时，这种影响更明显。
据我们所知，这是第一项显示CRC诊断前免疫谱与预后之间存在显著相关性的研究。
