术前外周血小板与淋巴细胞比值与结直肠癌术后患者临床预后研究

崔莹珊陈小林周航亮

【摘要】目的探讨术前外周血小板与淋巴细胞比值(PLR)判断结直肠癌术后患者临床预后的价值。方法收集822例结直肠癌患者的术前血常规结果，并对上述纳入患者进行为期5年的随访；用Kaplan-Meier曲线和多因素Cox回归评估术前PLR对其临床预后的影响，同时评价其临床预后预测列线图的预测价值。结果高PLR与TNM-Ⅲ期、低/未分化、肿瘤浸润深度(T3/T4)和淋巴结转移(N1/N2)相关。 Kaplan-Meier曲线结果表明术前PLR与术后结直肠癌患者的无复发生存期(RFS)、总生存期(OS)相关(P均<0.001)，高PLR是判断结直肠癌术后患者临床不良预后(RFS: P<0.001, HR=2.61, 95%CI=1.69～4.88; OS: P<0.001, HR=2.79, 95%CI= 1.63～4.28)的独立预测因子；以PLR为基础构建的复发预测列线图和死亡预测列线图的C-index分别为0.849和0.821，未含PLR因子构建的复发和死亡列线图的C-index分别0.792和0.775。结论术前高PLR与结直肠癌患者的术后RFS、OS呈负相关，术前PLR是结直肠癌患者术后RFS、OS的独立预后因子，由其构建的复发和死亡预测列线图可明显提高术后患者临床预后的预测效能。

【关键词】结直肠癌；外周血小板与淋巴细胞比值；列线图

收稿日期：(2015-05-06)

DOI：10.3969/g.issn.0253-9802.2015.10.011

通讯作者，王子莲，E-mail：wangzilian2005@aliyun.com

Preoperative platelet-lymphocyte ratio is an independent prognostic factor for colorectal cancerCuiYingshan,ChenXiaolin,ZhouHangliang.DepartmentofRadiotherapy，JinhuaCentralHospital,Jinhua321037，China

Abstract【】ObjectiveTo investigate the clinical significance of preoperative platelet-lymphocyte ratio (PLR) in predicting the clinical prognosis of colorectal cancer (CRC) patients after surgery. MethodsPreoperative blood routine test results were collected from 822 CRC cases. All enrolled patients were subject to 5-year follow-up. Kaplan-Meier curve and multiple Cox regression were utilized to evaluate the influence of preoperative platelet-lymphocyte ratio(PLR) on clinical outcomes of CRC patients and the value of predictive nomograms based on PLR was also analyzed. ResultsHigh PLR was associated with TNM-Ⅲ, low/non-differentiation, depth of tumor invasion (T3/T4) and lymph node metastasis (N1/N2). Preoperative PLR was significantly associated with recurrence-free survival (RFS) and overall survival (OS) (both P<0.001). High preoperative PLR was an independent prognostic factor for poor RFS (P<0.001, HR=2.52, 95%CI=1.69-4.88) and OS (P<0.001, HR=2.79, 95%CI=1.63-4.28). The C-indexes of RFS and OS predictive nomograms based on PLR were 0.849 and 0.821, and 0.792 and 0.775 for the C-indexes without PLR. ConclusionsHigh preoperative PLR is negatively correlated with RFS and OS in CRC patients, and it serves as an independent prognostic factor for clinical prognosis. PLR-based nomogram could significantly improve the accuracy in predicting the clinical prognosis in CRC individuals.

【Key words】Colorectal cancer; Platelet-lymphocyte ratio; Nomogram

结直肠癌是全球发病率和死亡率分别位列第三和第四位的严重影响人类健康的全球性疾病[1]。2011年我国共有310 244例患者被新诊断为结直肠癌, 149 722例此病患者死亡，新发和死亡的结直肠癌例数分别占全球的20%和25%[2]。虽然结直肠癌的临床诊治水平不断提高，但部分手术患者容易出现复发和转移，其5年总生存期有待提高。大量研究表明炎症参与的肿瘤微环境在结直肠癌的发生和发展过程中发挥重要作用[3]。外周血血小板与淋巴细胞比值(PLR)可反映体内炎症状态，部分研究结果显示PLR与卵巢癌、子宫内膜癌和胃癌等恶性肿瘤的临床预后相关[4-5]。然而PLR在结直肠癌术后患者中的临床预后价值尚无一致结论[6-7]。为此，我们收集进行结直肠癌手术切除患者临床资料，并对上述纳入患者进行为期5年的随访，分析术前PLR用于术后结直肠癌患者临床预后评估的临床价值。……