Huang Luyu, Zhao Kai, Lu Hongnan, He Wei, Miao Dazhuang, Wang Yan, Li Bingcai, Wang Qi, Jiang Shixiong, Jia Yunhe
Department of Colorectal Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, 150081, Heilongjiang, China.
Zigong Third People's Hospital, Zigong, 643000, Sichuan, China.
BMC Gastroenterol. 2025 Apr 29;25(1):319. doi: 10.1186/s12876-025-03932-w.
Although surgery-based comprehensive therapy is highly effective for treating stage I-III colorectal cancer, heterogeneity in survival trajectories still exists, necessitating precise prognostic stratification. Serum cholinesterase (CHE) and the platelet-to-hemoglobin ratio (PHR) are emerging as potential prognostic markers reflecting inflammation, nutritional status, and tumor biology. This study aims to investigate their combined value in predicting survival outcomes for stage I-III CRC patients, potentially offering a cost-effective tool for personalized management.
The study included 673 stage I-III CRC patients who underwent radical surgery at Harbin Medical University Cancer Hospital from January to August 2019 and January to March 2020. Comprehensive clinicopathological data were collected. The patients from 2019 were used for the primary research analysis. Kaplan-Meier analysis was used for survival comparisons, while Cox regression identified independent prognostic factors. Two nomograms were developed to predict the prognosis of DFS and OS and were validated in 2020 patient cohort.
A total of 475 patients from 2019 patient cohort were classified into three different risk groups: Group 1 (CHE ≥ 6213.3 U/L and PHR ≤ 3.03, n = 305), Group 2 (CHE < 6213.3 U/L or PHR > 3.03, n = 135), and Group 3 (CHE < 6213.3 U/L and PHR > 3.03, n = 35). Survival analysis indicated that CRC patients with low serum CHE levels and high PHR had a poorer prognosis (all p < 0.05), and the combined biomarker CHE-PHR effectively distinguished different prognostic risk groups (p < 0.001). Multivariate analysis identified Crea (p = 0.037), Eosi (p = 0.021), CA199 (p = 0.002), pTNM stage (p < 0.001), number of lymph nodes detected (p = 0.007), and CHE-PHR (p < 0.001) as independent prognostic factors for DFS, while CEA (p = 0.015), CA199 (p = 0.006), pTNM stage (p < 0.001), number of lymph nodes detected (p = 0.007), and CHE-PHR (p < 0.001) were independent prognostic factors for OS. In 2019 patient cohort t, the nomogram's AUC values for 1-, 3-, 5-year DFS are 0.825, 0.766, and 0.748, and for 1-, 3-, 5-year OS, they are 0.787, 0.743, and 0.756. In 2020 patient cohort, the AUC values are 0.776, 0.812, 0.736 for DFS, and 0.756, 0.818, 0.789 for OS.
Lower serum CHE and higher PHR levels are linked to poorer DFS and OS outcomes. The CHE-PHR indicator serves as an independent prognostic factor for stage I-III CRC patients post-surgery, aiding in predicting recurrence and metastasis.
尽管基于手术的综合治疗对I - III期结直肠癌的治疗非常有效，但生存轨迹仍存在异质性，因此需要精确的预后分层。血清胆碱酯酶（CHE）和血小板与血红蛋白比值（PHR）正逐渐成为反映炎症、营养状况和肿瘤生物学的潜在预后标志物。本研究旨在探讨它们在预测I - III期结直肠癌患者生存结局方面的综合价值，可能为个性化管理提供一种经济有效的工具。
该研究纳入了2019年1月至8月以及2020年1月至3月在哈尔滨医科大学附属肿瘤医院接受根治性手术的673例I - III期结直肠癌患者。收集了全面的临床病理数据。2019年的患者用于初步研究分析。采用Kaplan - Meier分析进行生存比较，同时采用Cox回归确定独立预后因素。开发了两个列线图来预测无病生存期（DFS）和总生存期（OS）的预后，并在2020年的患者队列中进行了验证。
2019年患者队列中的475例患者被分为三个不同风险组：第1组（CHE≥6213.3 U/L且PHR≤3.03，n = 305），第2组（CHE < 6213.3 U/L或PHR > 3.03，n = 135），第3组（CHE < 6213.3 U/L且PHR > 3.03，n = 35）。生存分析表明，血清CHE水平低且PHR高的结直肠癌患者预后较差（所有p < 0.05），联合生物标志物CHE - PHR能有效区分不同的预后风险组（p < 0.001）。多因素分析确定肌酐（Crea，p = 0.037）、嗜酸性粒细胞（Eosi，p = 0.021）、糖类抗原199（CA199，p = 为0.002）、pTNM分期（p < 0.001）、检测到的淋巴结数量（p = 0.007）和CHE - PHR（p < 0.001）为DFS的独立预后因素，而癌胚抗原（CEA，p = 0.015）、CA199（p = 0.006）、pTNM分期（p < 0.001）、检测到的淋巴结数量（p = 0.007）和CHE - PHR（p < 0.001）为OS的独立预后因素。在2019年患者队列中t，列线图预测1年、3年、5年DFS的AUC值分别为0.825、0.766和0.748，预测1年、3年、5年OS的AUC值分别为0.787、0.743和0.756。在2020年患者队列中，DFS的AUC值分别为0.776、0.812、0.736，OS的AUC值分别为0.756、0.818、0.789。
较低的血清CHE水平和较高的PHR水平与较差的DFS和OS结局相关。CHE - PHR指标是I - III期结直肠癌患者术后的独立预后因素，有助于预测复发和转移。
