术前外周血淋巴细胞与单核细胞比值对Ⅲ期结肠癌患者预后的评估价值  

Evaluation value of preoperative peripheral blood lymphocyte-to-monocyte ratio on the prognosis of patients with stage Ⅲ colon cancer

作　　者：陈建勋 彭健宏[1] 范文华[1] 张荣欣[1] 王福龙[1] 周文灏 许东波 潘志忠[1] 卢震海[1] Chen Jianxun;Peng Jianhong;Fan Wenhua;Zhang Rongxin;Wang Fulong;Zhou Wenhao;Xu Dongbo;Pan Zhizhong;Lu Zhenhai(Department of Colorectal Surgery,Sun Yat-sen University Cancer Center,State Key Laboratory of Oncology in South China,Collaborative Innovation Center for Cancer Medicine,Guangzhou 510060, China)

机构地区：[1]中山大学肿瘤防治中心结直肠科,华南肿瘤学国家重点实验室,肿瘤医学协同创新中心,广州510060

出　　处：《中华胃肠外科杂志》2019年第1期73-78,共6页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金面上项目(81772595);广东省科技计划项目(2016ZC0028).

摘　　要：目的探讨术前外周血淋巴细胞与单核细胞比值(LMR)对接受根治术及术后辅助化疗的Ⅲ期结肠癌患者预后的评估价值。方法检索电子病历系统,回顾性收集2007年12月至2013年12月期间,在中山大学肿瘤防治中心行根治术的病理学确诊结肠腺癌、临床病理资料完整、术后行XELOX(奥沙利铂、卡培他滨)方案化疗且术后随访至少3个月的Ⅲ期结肠癌患者病历资料,排除术前接受新辅助抗肿瘤治疗、伴有感染性疾病、合并其他恶性肿瘤以及术后3个月内因非肿瘤原因死亡的患者。共258例结肠癌患者被纳入本回顾性队列研究,男146例,女112例,中位年龄55(22~85)岁。100例(38.8%)肿瘤位于右半结肠,158例(61.2%)肿瘤位于左半结肠部位。194例(75.2%)肿瘤为高、中分化,64例(24.8%)为低分化。根据美国癌症联合委员会(AJCC)第7版TNM肿瘤病理分期,196例(76.0%)为ⅢA和ⅢB期、62例(24.0%)为ⅢC期。术前癌胚抗原水平中位数3.8(0.3~287.5)μg/L,术后辅助化疗疗程中位数6(1~8)个。通过受试者工作特征曲线(ROC)确定术前LMR预测3年总生存结局的最佳临界值,根据该临界值将全组患者分为低LMR组和高LMR组。采用χ^2检验或Fisher精确概率法检验比较两组临床病理特征。Kaplan-Meier计算并以Log-rank方法比较两组3年肿瘤无病生存率和总生存率,采用Cox回归模型进行单因素和多因素预后分析。结果ROC曲线显示,术前LMR预测3年总生存结局的最佳临界值为4.29,其中低LMR组(LMR<4.29)143例,高LMR组(LMR≥4.29)115例。与高LMR组相比,低LMR组中男性[62.2%(89/143)比50.4%(58/115),χ^2=4.167,P=0.041]、右半结肠癌[44.8%(64/143)比31.3%(36/115),χ^2=4.858,P=0.028]和肿瘤最大径>4cm[60.1%(86/143)比33.0%(38/115),χ^2=18.748,P<0.001]的比例更高。全组随访3.0~74.0(中位数46.0)个月,高LMR组与低LMR组的3年肿瘤无病生存率差异无统计学意义(83.8%比78.9%,P=0.210);而低LMR组的3年总生存率低于高Objective To investigate the evaluation value of preoperative peripheral blood lymphocyte-to-monocyte ratio(LMR)on the prognosis of patients with stage Ⅲ colon cancer undergoing radical resection and postoperative adjuvant chemotherapy.Methods Electronic medical record were retrospectively retrived for stage Ⅲ colon cancer patients who underwent radical surgery at Sun Yat-sen University Cancer Center from December 2007 to December 2013.Inclusion criteria were pathologically comfirmed colon adenocarcinoma,complete clinicopathological data,and postoperative XELOX(oxaliplatin+ capecitabine)chemotherapy with follow-up of at least 3 months.Patients with neoadjuvant anti-tumor therapy,infectious disease,other malignant tumors and death of non-tumor causes within 3 months after operation were excluded.A total of 258 patients were included in this retrospective cohort study,including 146 males and 112 females with median age of 55(22 to 85)years.Tumors of 100(38.8%)patients were located in the right hemicolon,and of 158(61.2%)in the left hemicolon.Tumors of 194(75.2%)patients were highly and moderately differentiated,and of 64(24.8%)were poorly differentiated.According to the TNM tumor pathological stage of AJCC 7th edition,196(76.0%)patients were stage ⅢA to ⅢB,and 62(24.0%)patients were stage ⅢC.The median preoperative CEA was 3.8(0.3 to 287.5)μg/L and the median cycle of the adjuvant chemotherapy was 6(1 to 8).The cut-off value of preoperative LMR in prediction of 3-year overall survival(OS)outcome was determined by receiver operating characteristic(ROC)curve analysis.All patients were divided into low LMR group and high LMR group according to the critical value.Clinicopathological characteristics between the two groups were compared by using chi-square test or Fisher's exact test as appropriate.The 3-year disease-free survival and overall survival rate were estimated with the Kaplan-Meier method,and differences between two groups were assessed with the log-rank test.Univariate and multivariate analyses wer

关 键 词：结直肠肿瘤 Ⅲ期 淋巴细胞与单核细胞比值 预后 

分 类 号：R735.35[医药卫生—肿瘤]