肿瘤免疫评分联合中性粒细胞与淋巴细胞比值、 血小板与淋巴细胞比值对结肠癌术后预后的价值研究  

Postoperative prognosis value of tumor immunoscore and NLR,PLR of colon cancer

作　　者：崔婧雯 李袁飞[1] CUI Jingwen;LI Yuanfei(Department of Oncology,The First Hospital of Shanxi Medical University,Taiyuan,Shanxi 030001,China)

机构地区：[1]山西医科大学第一医院肿瘤科,山西太原030001

出　　处：《安徽医药》2024年第7期1381-1387,I0003,共8页Anhui Medical and Pharmaceutical Journal

基　　金：山西省省筹资金资助回国留学人员科研项目(2020-171);山西省人社厅留学办科研活动择优资助项目(1176)。

摘　　要：目的探究免疫评分(IS)单独及联合外周血炎症标志物对结肠癌病人术后预后的预测价值。方法以2013年1月至2019年12月在山西医科大学第一医院接受结肠癌根治术81例为研究对象,进行为期5年的跟踪随访。收集病人所有的临床病理资料,并通过免疫组化对所有病人术后病理标本进行免疫评分。行χ^(2)检验、Kaplan-Meier生存分析、Cox回归、构建列线图(nomogram)模型和时间依赖的受试者操作特征曲线(tROC曲线)等分析比较临床病理因素、免疫评分、外周血炎症标志物等与病人总生存期(OS)和无病生存期(DFS)的关系。结果生存分析结果显示,高免疫评分水平与病人的TNM分期(38例Ⅰ~Ⅱ期,43例Ⅲ~Ⅳ期,P=0.006)、术前糖类抗原199(64例CA199≤35μg/L,17例CA199>35μg/L,P=0.038)有关。免疫评分(IS≥3比IS<3)、中性粒细胞与淋巴细胞比值(NLR≤2.82比NLR>2.82)、血小板与淋巴细胞比值(PLR≤113.15比PLR>113.15)、术前糖类抗原199(CA199)(CA199≤35μg/L比CA199>35μg/L)是病人的独立预后因素。将有预后价值的变量整合,建立OS和DFS的列线图预测模型,模型C指数为0.79和0.76,校准曲线均表现出良好的一致性。tROC曲线也证明了该列线图模型预测结肠癌术后的预后价值高于单一指标和传统的TNM分期系统,其曲线下面积(AUC)分别为0.88(3年OS)、0.85(5年OS)、0.84(3年DFS)、0.82(5年DFS)。结论免疫评分联合NLR、PLR、CA199对结肠癌病人术后预后有较高的预测价值,可为结肠癌预后判断及治疗方案的选择提供依据,值得临床推广应用。Objective To explore the predictive value of immunoscore(IS)alone or in combination with peripheral inflammatory markers for postoperative prognosis of patients with colon cancer.Methods 81 cases of colon cancer,who underwent radical resection in The First Hospital of Shanxi Medical University from January 2013 to Decemember 2019,were selected as research objects and followed up for 5 years after surgery.The clinicopathological data of all patients were collected,and immunohistochemistry(IHC)was used to calculate the IS of postoperative pathological specimens.Chi-square test,Kaplan-Meier estimates,Cox proportional hazard regression analyses,nomogram model and time-dependent receiver operating characteristic(tROC)curve were performed to analyse the correlation between clinicopathological features,IS,peripheral inflammatory markers and overall survival(OS)and disease free survival(DFS)of patients.Results Survival analysis results showed that high IS was related with TNM staging(38 cases of StageⅠ-Ⅱ,43 cases of StageⅢ-Ⅳ,P=0.006)and preoperative carbohydrate antigen 199(CA 199)(CA 199 of 64 cases≤35μg/L,CA 199 of 17 cases>35μg/L,P=0.038).IS(IS≥3 vs.IS<3),neutrophil to lymphocyte ratio(NLR≤2.82 vs.NLR>2.82),platelet to lymphocyte ratio(PLR≤113.15 vs.PLR>113.15)and CA 199(CA 199≤35μg/L vs.CA 199>35μg/L)were independent prognostic factors for patients.The above parameters with prognostic value were integrated to construct the nomogram for OS and DFS.The concordance indexes(C-index)of the nomogram were 0.79 and 0.76,and calibration curves displayed high accordance with actual observed values.tROC also confirmed that the nomogram had higher significance in predicting the prognostic value than a single marker or traditional TNM staging,with AUC values of 0.88(3-year OS),0.85(5-year OS),0.84(3-year DFS),and 0.82(5-year DFS).Conclusion Tumor immunoscore in combination with NLR,PLR,and CA 199 has a high predictive value for the prognosis of patients with colon cancer,which can provide support for the pro

关 键 词：结肠肿瘤 肿瘤免疫评分 中性粒细胞与淋巴细胞比值 血小板与淋巴细胞比值 预后 

分 类 号：R735.35[医药卫生—肿瘤]