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目的探讨术前外周血中性粒细胞与淋巴细胞比值(NLR)与派生中性粒细胞与淋巴细胞比值(d-NLR)对评估结直肠癌(CRC)手术患者预后的价值。方法收集555例CRC根治性切除手术患者临床病理资料,并对其进行5年随访;利用ROC曲线确定NLR和d-NLR的cut-off值,Kaplan-Meier曲线和多重Cox回归分析NLR、d-NLR与CRC术后患者预后的关系,并构建临床预后预测列线图评价预测价值。结果以总生存期为判断终点,NLR(灵敏度=0.752,特异度=0.753,AUC=0.762)与d-NLR(灵敏度=0.721,特异度=0.683,AUC=0.720)的cut-off值分别为3.21和2.12;Kaplan-Meier曲线显示,术前NLR、d-NLR与CRC术后患者的无复发生存期和总生存期相关(P<0.01);多因素COX回归分析显示,NLR和d-NLR水平高是判断CRC术后患者无复发生存期(HRNLR=2.53,HRd-NLR=1.60)和总生存期(HRNLR=2.75,HRd-NLR=2.11)的独立预测因子;按包含与未包含NLR、d-NLR两因子分别构建无复发生存期和总生存期预测列线图,其C指数分别为0.851、0.836和0.801、0.793。结论术前NLR和d-NLR水平高则CRC术后患者无复发生存期和总生存期明显缩短;术前NLR和d-NLR可作为评估肿瘤II~III期CRC患者术后无复发生存期和总生存期的独立预后因子。
Objective To investigate the value of preoperative peripheral blood neutrophil to lymphocyte ratio (NLR) and derived neutrophil to lymphocyte ratio (d-NLR) in assessing the prognosis of colorectal cancer (CRC) patients. Methods The clinical and pathological data of 555 cases of radical resection of CRC were collected and followed up for 5 years. The cut-off values of NLR and d-NLR were determined by ROC curve, Kaplan-Meier curves and multiple Cox regression analysis of NLR, d- NLR and postoperative prognosis of patients with CRC, and build clinical prognosis prognosis nomogram to assess the predictive value. Results The cut-off values of NLR (sensitivity = 0.752, specificity = 0.753, AUC = 0.762) and d-NLR (sensitivity = 0.721, specificity = 0.683, AUC = 0.720) were 3.21 And 2.12 respectively. Kaplan-Meier curves showed that preoperative NLR and d-NLR were associated with recurrence-free survival and overall survival (P <0.01) in CRC patients. Multivariate COX regression analysis showed that the levels of NLR and d-NLR High was an independent predictor of recurrence-free survival (HRNLR = 2.53, HRd-NLR = 1.60) and overall survival (HRNLR = 2.75, HRd-NLR = 2.11) -NLR two factors were constructed recurrence-free survival and overall survival predicted collinear chart, the C index were 0.851,0.836 and 0.801,0.793. Conclusion The high preoperative NLR and d-NLR levels in patients with CRC postoperative recurrence-free survival and overall survival was significantly shorter; preoperative NLR and d-NLR can be used as a tumor in patients with stage II ~ III recurrence-free survival and Overall survival independent prognostic factor.