术前炎症指标与直肠癌患者预后的关系及预后列线图预测模型的建立  

Relationship between preoperative inflammatory indexes and prognosis of patients with rectal cancer and establishment of prognostic nomogram prediction model

作　　者：张磊[1] 时飞宇 秦倩 刘改霞 张浩为 阎俊[1] 谭敏 王黎昭 薛栋 胡晨浩 张喆[1] 佘军军[1] Zhang Lei;Shi Feiyu;Qin Qian;Liu Gaixia;Zhang Haowei;Yan Jun;Tan Min;Wang Lizhao;Xue Dong;Hu Chenhao;Zhang Zhe;She Junjun(Department of General Surgery,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China)

机构地区：[1]西安交通大学第一附属医院普通外科,西安710061

出　　处：《中华肿瘤杂志》2022年第5期402-409,共8页Chinese Journal of Oncology

基　　金：国家自然科学基金(82173394)陕西省创新能力支撑计划项目(2021TD-41)。

摘　　要：目的探讨术前中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)、淋巴细胞与单核细胞比值(LMR)和系统免疫炎症指数(SII)等炎症指标对直肠癌患者预后的预测价值,并构建基于炎症指标的生存预测模型。方法收集2013年1月至2016年12月于西安交通大学第一附属医院行根治性切除的585例直肠癌患者的临床和生存资料,采用受试者工作特征(ROC)曲线确定术前NLR、PLR、LMR和SII的最佳界值,比较不同NLR、PLR、LMR和SII水平患者的临床病理特征。采用Kaplan-Meier法进行生存分析,采用Cox比例风险模型进行预后影响因素的单因素和多因素回归分析。应用R软件构建直肠癌患者的总生存和无病生存列线图预测模型,计算C指数评估模型的准确性,绘制校准图评价模型的预测效能。结果术前NLR、PLR、LMR和SII水平预测直肠癌患者术后总生存的最佳界值分别为2.44、134.88、4.70和354.18。低NLR组与高NLR组患者的肿瘤分化程度差异有统计学意义(P<0.05),低PLR组与高PLR组患者的T分期、N分期、TNM分期、肿瘤分化程度和术前癌胚抗原(CEA)差异有统计学意义(均P<0.05),低LMR组与高LMR组患者的肿瘤分化程度有统计学意义(P<0.05),低SII组与高SII组患者的T分期、N分期、TNM分期、肿瘤分化程度和术前CEA差异有统计学意义(均P<0.05)。多因素Cox回归分析显示,年龄(HR=2.221,95%CI为1.526~3.231)、TNM分期(Ⅲ期:HR=4.425,95%CI为1.848~10.596)、肿瘤分化程度(HR=1.630,95%CI为1.074~2.474)、SII(HR=2.949,95%CI为1.799~4.835)及术后辅助放化疗(HR=2.123,95%CI为1.506~2.992)为直肠癌患者总生存的独立影响因素,年龄(HR=2.107,95%CI为1.535~2.893)、TNM分期(Ⅲ期:HR=2.850,95%CI为1.430~5.680)、肿瘤分化程度(HR=1.681,95%CI为1.150~2.457)、SII(HR=2.309,95%CI为1.546~3.447)及术后辅助放化疗(HR=1.837,95%CI为1.369~2.464)为直肠癌患者无病生存的独立影响因素。根据多因素Cox回归分析Objective To compare the prognostic evaluation value of preoperative neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR),lymphocyte-to-monocyte ratio(LMR),and systemic immune-inflammation index(SII)in rectal cancer patients.Nomogram survival prediction model based on inflammatory markers was constructed.Methods The clinical and survival data of 585 patients with rectal cancer who underwent radical resection in the First Affiliated Hospital of Xi′an Jiao tong University from January 2013 to December 2016 were retrospectively analyzed.The optimal cut-off values of NLR,PLR,LMR,and SII were determined by the receiver operating characteristic(ROC)curve.The relationship between different NLR,PLR,LMR and SII levels and the clinic pathological characteristics of the rectal cancer patients were compared.Cox proportional risk model was used for univariate and multivariate regression analysis.Nomogram prediction models of overall survival(OS)and disease-free survival(DFS)of patients with rectal cancer were established by the R Language software.The internal validation and accuracy of the nomograms were determined by the calculation of concordance index(C-index).Calibration curve was used to evaluate nomograms‘efficiency.Results The optimal cut-off values of preoperative NLR,PLR,LMR and SII of OS for rectal cancer patients were 2.44,134.88,4.70 and 354.18,respectively.There was statistically significant difference in tumor differentiation degree between the low NLR group and the high NLR group(P<0.05),and there were statistically significant differences in T stage,N stage,TNM stage,tumor differentiation degree and preoperative carcinoembryonic antigen(CEA)level between the low PLR group and the high PLR group(P<0.05).There was statistically significant difference in tumor differentiation degree between the low LMR group and the high LMR group(P<0.05),and there were statistically significant differences in T stage,N stage,TNM stage,tumor differentiation degree and preoperative CEA level between the low S

关 键 词：直肠肿瘤 预后 列线图 炎症指标 系统免疫炎症指数 

分 类 号：R735.37[医药卫生—肿瘤]