【摘要】 目的：探讨结直肠癌（CRC）根治术前后外周血中性粒细胞与淋巴细胞比值变化值（ΔNLR）、术前预后营养指数（PNI和血清癌胚抗原（CEA）水平对CRC病人术后预后不良的预测价值。方法：回顾性分析行CRC根治术治疗病人182例临床资料，根据病人术后5年生存情况将其分为预后良好组和预后不良组。比较2组病人外周血ΔNLR、术前PNI和血清CEA水平，采用Cox回归分析CRC病人根治术后预后不良的影响因素，采用ROC曲线分析外周血ΔNLR、术前PNI和血清CEA水平对CRC根治术病人预后不良的预测效能，绘制Kaplan-Meier生存曲线分析不同ΔNLR、PNI、CEA病人CRC根治术后生存率关系。结果：CRC病人根治术后5年死亡率为37.36%(68/182)，预后不良组外周血ΔNLR、术前血清CEA水平均明显高于预后良好组（P <0.01），术前PNI明显低于预后良好组（P <0.01）；预后不良组肿瘤TNM分期Ⅲ期、伴有脉管浸润和神经侵犯病人比例均高于预后良好组（P <0.05～P <0.01），而2组年龄、性别、CRC家族史、肿瘤部位、肿瘤直径、手术时间差异均无统计学意义（P> 0.05）。Cox回归分析显示，TNM分期、脉管浸润、神经侵犯、外周血ΔNLR、术前PNI和血清CEA水平均为CRC病人根治术后预后的独立影响因素（P <0.05～P <0.01）;ROC曲线分析显示，外周血ΔNLR、术前PNI和血清CEA水平联合预测CRC病人根治术后预后不良的灵敏度和AUC均高于单项预测（P <0.05）。Kaplan-Meier生存曲线分析显示，ΔNLR> 1.87、PNI≤48.87、CEA> 8.95 ng/mL病人CRC根治术后5年生存率分别明显低于ΔNLR≤1.87、PNI>48.87、CEA≤8.95 ng/mL病人（P <0.01）。结论：外周血ΔNLR、术前PNI和血清CEA水平与CRC根治术病人预后密切相关，三者联合预测效能更佳。更多还原

【Abstract】 Objective: To investigate the value of peripheral blood neutrophil to lymphocyte ratio before and after radical operation(ΔNLR), preoperative prognostic nutritional index(PNI) and serum carcinoembryonic antigen(CEA) levels in predicting the poor prognosis of patients with colorectal cancer(CRC) after radical resection. Methods: The clinical data of 182 patients treated with radical resection of CRC were retrospectively analyzed, and the patients were divided into the good prognosis group and poor prognosis group according to the survival conditions at 5 years after operation. The ΔNLR in peripheral blood, preoperative PNI and serum CEA levels were compared between two groups, and the Cox regression was used to analyze the independent influencing factors of poor prognosis of CRC patients after radical resection, and ROC curve was used to analyze the predictive efficacy ofΔNLR in peripheral blood, preoperative PNI and serum CEA levels on poor prognosis of patients with CRC after radical resection.Kaplan-Meier survival curves were drawn to compare the survival rates of patients with CRC after radical resection with differentΔNLR, PNI and CEA levels. Results: The 5-year mortality rate of CRC patients after radical resection was 37.36%(68/182). TheΔNLR in peripheral blood and preoperative serum CEA levels in poor prognosis group were higher than those in good prognosis group(P < 0.01), but the preoperative PNI was lower than that in good prognosis group(P < 0.01). The proportions of patients with TNM stage Ⅲ, vascular invasion and nerve invasion in the poor prognosis group were higher than those in good prognosis group(P < 0.05 to P < 0.01), but there was no statistical significance in the age, gender, family history of CRC, tumor location, tumor size and operation time between two groups(P > 0.05). The results of Cox regression analysis showed that the TNM stage, vascular infiltration, nerve invasion, ΔNLR in peripheral blood, preoperative PNI and serum CEA levels were the independent influencing factors of poor prognosis of CRC patients after radical resection(P < 0.05 to P < 0.01). The results of ROC curve showed that the sensitivity and AUC of the joint ΔNLR in peripheral blood, preoperative PNI and serum CEA level in predicting the poor prognosis of CRC patients after radical resection were higher than that of single prediction(P < 0.05). The results of Kaplan-Meier survival curve analysis show that the 5-year survival rates of patients with CRC after radical resection with ΔNLR > 1.87, PNI ≤ 48.87 and CEA > 8.95 ng/mL were significantly lower than those patients with ΔNLR ≤ 1.87, PNI > 48.87, CEA ≤ 8.95 ng/mL(P < 0.01).Conclusions: The ΔNLR in peripheral blood, preoperative PNI and serum CEA levels are closely related to the prognosis of CRC patients after radical resection, and the predictive efficacy of the combination of the three is better.更多还原