基于外周血细胞综合评分的结直肠癌患者预后预测模型的构建  

Peripheral blood cell count composite score as a prognostic factor in patients with colorectal cancer

作　　者：郭培源 胡旭华[1] 李保坤 路逖 刘佳明 王超宇 牛文博 王贵英[1,2,3] 于滨 Guo Peiyuan;Hu Xuhua;Li Baokun;Lu Ti;Liu Jiaming;Wang Chaoyu;Niu Wenbo;Wang Guiying;Yu Bin(The Second Department of General Surgery,the Fourth Hospital of Hebei Medical University,Shijiazhuang 050001,China;Department of General Surgery,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China;Hebei Key Laboratory of Etiology Tracing and Individualized Diagnosis and Treatment for Digestive system carcinoma,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第四医院外二科,石家庄050001 [2]河北医科大学第二医院普通外科,石家庄050000 [3]河北省消化道肿瘤病因溯源和个体化诊疗实验室,石家庄050000

出　　处：《中华胃肠外科杂志》2024年第9期953-965,共13页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金(82272909);河北省自然科学基金(2022206355);河北省2023年度医学科学研究课题计划(20230103)。

摘　　要：目的构建基于外周血细胞评分系统的结直肠癌患者预后预测模型。方法本研究为回顾性观察性研究。纳入标准:(1)未发生远处转移的原发性结直肠癌患者;(2)术前未行放疗或化学治疗;(3)术前1个月内未行升白细胞及升血小板治疗;(4)术后病理证实为结直肠腺癌,且肿瘤达到完整切除。排除术前存在严重贫血、感染或血液系统疾病者以及合并严重心、肺等重要器官疾病或合并其他恶性肿瘤的患者。回顾性纳入2018年4月至2020年4月期间经河北医科大学第四医院外二科同一治疗组行手术治疗的1021例结直肠癌患者作为本研究的训练集(766例)及内部验证(255例);同时,采用相同标准,选取2015年3月至2020年12月期间,经另一治疗组行手术治疗的215例结直肠癌患者作为外部验证。使用R软件中的“surv_cutpoint”函数分析中性粒细胞、淋巴细胞及血小板的最佳界值,依据最佳界值建立外周血细胞评分系统。外周血细胞评分系统(PBCS)评分规则如下:中性粒细胞和血小板低于最佳界值=1分,否则记为0分;淋巴细胞高于最佳界值=1分,否则记为0分。三种细胞的得分情况相加,即为外周血细胞评分。应用单多因素Cox回归分析探究患者临床病理特征与预后的相关性,并在Cox回归分析的基础上构建列线图以预测患者预后。使用C指数、校准曲线及决策曲线分析验证列线图预测模型的准确性。结果中性粒细胞、淋巴细胞和血小板的最佳界值分别为4.40×10^(9)/L,1.41×10^(9)/L和355×10^(9)/L。按照上述细胞的最佳界值,分别将患者分为高组和低组。生存曲线分析显示,高淋巴细胞(训练集:P=0.042,内部验证:P=0.010,外部验证:P=0.029)、低中性粒细胞(训练集:P=0.035,内部验证:P=0.001,外部验证:P=0.024)及低血小板(训练集:P=0.041,内部验证:P=0.030,外部验证:P=0.024)有利于患者总体生存期(OS)的延长,差异均有统计学意义。不同Objective To develop a prognostic prediction model for patients with colorectal cancer based on a peripheral blood cell composite score(PBCS)system.Methods This retrospective observational study included patients who had primary colorectal cancer without distant metastasis,who did not undergo radiotherapy or chemotherapy before surgery,who did not receive leukocyte or platelet-raising therapy within 1 month before surgery,and whose postoperative pathology confirmed colorectal adenocarcinoma with complete tumor resection.Patients with severe anemia,infection,or hematologic diseases before surgery,as well as those with severe heart,lung,or other important organ diseases or concurrent malignant tumors,were excluded.In total,1021 patients with colorectal cancer who underwent surgical treatment in the Department of Gastrointestinal Surgery of the Fourth Hospital of Hebei Medical University from April 2018 to April 2020 were retrospectively included as the training set(766 patients)and the internal validation set(255 patients).Additionally,using the same criteria,215 patients with colorectal cancer who underwent surgical treatment in another treatment group from March 2015 to December 2020 were selected as the external validation set.The"surv_cutpoint"function in R software was used to analyze the optimal cut-off values of neutrophils,lymphocytes,and platelets,and a PBCS system was established based on the optimal cut-off values.The scoring rules of the PBCS system were as follows:Neutrophils and platelets below the optimal cut-off value=1 point,otherwise 0 points;Lymphocytes above the optimal cut-off value=1 point,otherwise 0 points.The scores of the three cell types were added together to obtain the PBCS.Univariate and multivariate Cox regression analyses were performed to explore the correlation between patients'clinicopathological features and prognosis,and a nomogram was constructed based on the Cox regression analysis to predict patients'prognosis.The accuracy of the nomogram prediction model was validated using

关 键 词：结直肠肿瘤 中性粒细胞 淋巴细胞 血小板 预后 

分 类 号：R735.34[医药卫生—肿瘤]