术前全身炎性反应指数对结直肠癌患者预后的影响  

Effect of preoperative systemic inflammatory response index on prognosis in patients with colorectal cancer

作　　者：赵飞鸿 顾宇宏 赵悦[1] 王春敬[1] 王夫景[1] Zhao Feihong;Gu Yuhong;Zhao Yue;Wang Chunjing;Wang Fujing(Department of General Surgery,the Second Affiliated Hospital of Harbin Medical University,Harbin 150081,China)

机构地区：[1]哈尔滨医科大学附属第二医院普外科,哈尔滨150081

出　　处：《中国医师进修杂志》2025年第3期263-268,共6页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨可切除结直肠癌患者术前全身炎性反应指数(SIRI)对预后的影响。方法回顾性分析2018年1月至2022年12月哈尔滨医科大学附属第二医院355例因结直肠癌行根治性切除术患者的临床资料。记录患者的基本资料、病理资料和实验室检查结果,计算SIRI。患者随访截止时间2023年12月或死亡,记录总生存期(OS)和无病生存期(DFS)。绘制受试者工作特征(ROC)曲线,根据Yoden指数最大确定结直肠癌患者的SIRI最佳临界值,并以此为依据进行分组。采用多因素Cox回归分析影响结直肠癌患者预后的独立危险因素。绘制Kaplan-Meier生存曲线,比较采用log-rank检验。结果ROC曲线分析结果显示,SIRI的最佳临界值为0.99,曲线下面积为0.556。355例结直肠癌患者中,SIRI<0.99229例(低SIRI组),SIRI≥0.99126例(高SIRI组)。两组性别构成、年龄、体质量指数(BMI)、术前癌胚抗原(CEA)、术前癌抗原19-9(CA19-9)、肿瘤位置、T分期、N分期、肿瘤分期、分化程度、肿瘤长径、淋巴浸润、血管浸润、手术时间和术中出血量比较差异无统计学意义(P>0.05);高SIRI组吻合口瘘发生率明显高于低SIRI组[20.6%(26/126)比12.2%(28/229)],差异有统计学意义(P<0.05)。355例患者中位随访时间21.7个月,高SIRI组病死率和复发率明显高于低SIRI组[28.6%(36/126)比19.2%(44/229)和13.5%(17/126)比6.1%(14/229)],差异有统计学意义(P<0.05)。Kaplan-Meier生存曲线分析结果显示,高SIRI组中位OS和DFS明显低于低SIRI组(17.3个月比23.3个月和15.1个月比21.9个月),差异有统计学意义(P<0.05)。多因素Cox回归分析结果显示,肿瘤分期Ⅲ~Ⅳ期、术前CEA>5μg/L和SIRI>0.99是影响结直肠癌患者OS和DFS的独立危险因素(OS:HR=2.447、1.951和1.923,95%CI 1.461~4.099、1.266~3.456和1.003~2.655,P<0.05;DFS:HR=2.982、1.782和1.529,95%CI 1.663~4.754、1.147~2.651和1.198~2.021,P<0.05)。结论术前SIRI是影响结直肠癌患者预后的独立危险因素,�Objective To investigate the effect of preoperative systemic inflammatory response index(SIRI)on prognosis in patients with resectable colorectal cancer.Methods The clinical data of 355 colorectal cancer patients underwent radical resection from January 2018 to December 2022 in the Second Affiliated Hospital of Harbin Medical University were retrospectively analyzed.The basic information,pathological data and laboratory test results were recorded,and SIRI was calculated.The patients followed up to December 2023 or death,and the overall survival(OS)and disease-free survival(DFS)were recorded.The receiver operating characteristic(ROC)curve was drawn,the optimal critical value of SIRI in patients with colorectal cancer was determined according to the maximum Yoden index,and the patients were grouped based on this.Multivariate Cox regression analysis was used to analyze the independent risk factors of prognosis in patients with colorectal cancer.Kaplan-Meier survival curve was drawn,and the log-rank test was used for comparison.Results ROC curve analysis result showed that the optimal critical value of SIRI was 0.99,and the area under the curve was 0.556.Among the 355 patients with colorectal cancer,SIRI<0.99 was in 229 cases(low SIRI group),and SIRI≥0.99 was in 126 cases(high SIRI group).There were no statistical difference in gender composition,age,body mass index(BMI),preoperative carcinoembryonic antigen,preoperative cancer antigen 19-9(CA19-9),tumor location,T stage,N stage,tumor stage,degree of differentiation,tumor long diameter,lymphatic invasion,vascular invasion,operating time and intraoperative blood loss between two groups(P>0.05).The incidence of anastomotic leakage in high SIRI group was significantly higher than that in low SIRI group:20.6%(26/126)vs.12.2%(28/229),and there was statistical difference(P<0.05).The median follow-up time of 355 patients was 21.7 months.The mortality and recurrence rate in high SIRI group were significantly higher than those in low SIRI group:28.6%(36/126)vs.19.2%(44/229)

关 键 词：结直肠肿瘤 预后 无病生存 全身炎性反应指数 

分 类 号：R73[医药卫生—肿瘤]