CAJ | 학술논문

目的评价术前及术后化疗前外周血中性/淋巴细胞比例(NLR)的动态变化对结肠癌无复发生存的预测价值.方法收集2003年1月至2011年1月间在中山大学附属第五医院接受根治性手术并术后6个疗程FOLFOX6方案(氟尿嘧啶、四氢叶酸和奥沙利铂)化疗的149例结肠癌患者的临床资料.所有患者均于术前及第1次化疗前进行血常规检查以获得NLR值.分析NLR及其动态变化对患者无复发生存的预测价值.结果 149例结肠癌患者外周血NLR为2.8±1.5,根据受试者工作特征曲线,当NLR取3.5作为截点时,其对术后无复发生存的预测价值最高.按此最佳截点,将患者分为高NLR组和低NLR组.术前低NLR组(127例)5年无复发生存率为76.4％,明显高于术前高NLR组(22例)的50.9％(P=0.025).化疗前低NLR组(115例)的5年无复发生存率为71.4％,明显高于化疗前高NLR组(34例)的50.1％(P=0.032).12例患者在手术后化疗前NLR值由术前大于3.5下降至小于3.5(降低组),其5年无复发生存率为79.5％,与化疗前低NLR组比较,差异无统计学意义(P=0.978).有16例患者NLR值由术前小于3.5上升至大于3.5(升高组),其5年无复发生存率为17.7％,与化疗前高NLR组比较,差异无统计学意义(P=0.077).术后升高组与降低组5年无复发生存率的比较,差异有统计学意义(P=0.036).结论无论是术前还是术后化疗前,高NLR都提示结肠癌患者无复发生存状态不佳,动态检测其变化有助于评估患者预后,并为制订个体化治疗措施提供参考.
목적 평개술전급술후화료전외주혈중성/림파세포비례(NLR)적동태변화대결장암무복발생존적예측개치.방법 수집2003년1월지2011년1월간재중산대학부속제오의원접수근치성수술병술후6개료정FOLFOX6방안(불뇨밀정、사경협산화오사리박)화료적149례결장암환자적림상자료.소유환자균우술전급제1차화료전진행혈상규검사이획득NLR치.분석NLR급기동태변화대환자무복발생존적예측개치.결과 149례결장암환자외주혈NLR위2.8±1.5,근거수시자공작특정곡선,당NLR취3.5작위절점시,기대술후무복발생존적예측개치최고.안차최가절점,장환자분위고NLR조화저NLR조.술전저NLR조(127례)5년무복발생존솔위76.4％,명현고우술전고NLR조(22례)적50.9％(P=0.025).화료전저NLR조(115례)적5년무복발생존솔위71.4％,명현고우화료전고NLR조(34례)적50.1％(P=0.032).12례환자재수술후화료전NLR치유술전대우3.5하강지소우3.5(강저조),기5년무복발생존솔위79.5％,여화료전저NLR조비교,차이무통계학의의(P=0.978).유16례환자NLR치유술전소우3.5상승지대우3.5(승고조),기5년무복발생존솔위17.7％,여화료전고NLR조비교,차이무통계학의의(P=0.077).술후승고조여강저조5년무복발생존솔적비교,차이유통계학의의(P=0.036).결론 무론시술전환시술후화료전,고NLR도제시결장암환자무복발생존상태불가,동태검측기변화유조우평고환자예후,병위제정개체화치료조시제공삼고.
Objective To evaluate whether neutrophil-lymphocyte ratio(NLR)predicts risk of recurrence in patients with advanced colon cancer undergoing curative resection followed by adjuvant chemotherapy.Methods A total of 149 patients with advanced colon cancer undergoing curative resection followed by adjuvant chemotherapy(FOLFOX6 protocol)were included.NLR was calculated preoperatively and before chemotherapy.The changes in NLR and the predictive value of NLR for prognosis were analyzed.Results The NLR of 149 patients was 2.8±1.5.NLR of 3.5 was identified according to the ROC curve.NLR＜3.5 and NLR ≥3.5 were classified as low and high NLR group,respectively.The 5-year recurrence-free survival(RFS)of patients with high preoperative NLR(n=22)was significantly worse than that of those with low preoperative NLR(n=127)(50.9％ vs.76.4％,P=0.025).The difference of 5-year RFS between high pre-chemotherapy NLR group(n=34)and low pre-chemotherapy NLR group(n=115)was statistically significant(50.1％ vs.71.4％,P=0.032).The 5-year RFS was 79.5％ in patients with low preoperative NLR converting to high pre-chemotherapy NLR(n=16),similar to the group with high prechemotherapy group(P=0.077).The 5-year RFS was 17.7％ in patients with high preoperative NLR reverting to low pre-chemotherapy NLR(n=12),similar to the group with low pre-chemotherapy group(P=0.978).There was significant difference in 5-year RFS between the postoperatively elevated group and postoperatively decreased group(P=0.036).Conclusion An elevated blood NLR may be a biomarker of poor RFS in patients with advanced colon cancer after curative resection and chemotherapy.