术前中性粒细胞-淋巴细胞比值与C反应蛋白-白蛋白比值联合评分对根治性结直肠癌患者预后的临床价值

目的探讨术前外周血中性粒细胞-淋巴细胞比值（NLR）、C反应蛋白-白蛋白比值（CAR）以及联合评分（NLR-CAR）对根治性结直肠癌患者预后的临床意义。 方法回顾性分析2015年1月至2017年1月在蚌埠医学院第一附属医院行根治手术的175例结直肠癌患者的临床资料，通过受试者工作特征（ROC）曲线确定NLR、CAR最佳截断值，将患者分为低NLR组（0分）、高NLR组（1分）；低CAR组（0分）、高CAR组（1分），通过两者分数之和得出NLR-CAR评分，将所有患者分为3组：NLR-CAR 0分组（低NLR+低CAR），NLR-CAR 1分组（高NLR或高CAR其中一项），NLR-CAR 2分组（高NLR+高CAR）。采用Kaplan-Meier生存曲线进行生存分析，Cox比例风险模型研究独立预后因素，通过ROC曲线比较NLR、CAR、NLR+CAR联合评估和NLR-CAR评分对患者预后的预测价值。 结果术后随访5年死亡64例（36.57%）。术前NLR、CAR的最佳截断值分别为2.970、0.124。低NLR组、低CAR组患者的5年生存率分别明显高于高NLR组、高CAR组（χ²=38.654、20.745，均P<0.001），NLR-CAR 0分组患者术后1、3、5年生存率优于NLR-CAR 1分组或NLR-CAR 2分组（χ²=48.425，P<0.001）。多因素分析结果显示，年龄、N分期、TNM分期、NLR、CAR和NLR-CAR评分是影响结直肠癌根治术后患者生存的独立相关因素（均P<0.05）。与NLR、CAR和NLR+CAR联合评估相比，NLR-CAR评分的曲线下面积最大，预测价值更高。 结论NLR-CAR评分与结直肠癌患者的预后存在相关性，是一种潜在的基于炎症的预后评分指标，其评估结直肠癌的预后优于单独的NLR或CAR，具有更大的临床价值。

A joint score in the prognosis evaluation of radical colorectal cancer: combination of the preoperative neutrophil to lymphocyte ratio with C-reactive protein to albumin ratio

ObjectiveTo explore the clinical significance of preoperative peripheral blood neutrophil to lymphocyte ratio (NLR), C-reactive protein to albumin ratio (CAR) and the joint score (NLR-CAR) in patients with radical colorectal cancer. MethodsClinical data of 175 patients with colorectal cancer undergoing radical surgery in the First Affiliated Hospital of Bengbu Medical College from January 2015 to January 2017 were analyzed retrospectively. The cut-off value of NLR and CAR were determined by the receiver operating characteristic (ROC) curve, and the patients were divided into low NLR group (0 point) and high NLR group (1 point); low CAR group (0 point), high CAR group (1 point); NLR-CAR 0 group (low NLR+low CAR), NLR-CAR 1 group (either high NLR or high CAR), NLR-CAR 2 group (high NLR+high CAR). Survival analysis was performed using the Kaplan-Meier survival curve, and the Cox proportional hazard model studied independent prognostic factors. The predictive prognostic value of the combined NLR, CAR, NLR + CAR test and NLR-CAR score on patients’ outcomes were estimated by the ROC curve. Results64 patients (36.57%) died after 5 years of postoperative follow-up. The best cut-off values for the preoperative NLR and CAR were 2.970 and 0.124, respectively. The 5-year survival rate of patients with low NLR and low CAR was significantly higher than those with high NLR and high CAR ( χ²=38.654, 20.745, both P<0.001), and the post-operative survival rate of NLR-CAR 0 group was better than NLR-CAR 1 group or NLR-CAR 2 group ( χ²=48.425, P<0.001). The results of multivariate analysis showed that age, N staging, TNM staging, NLR, CAR, and NLR-CAR scores were independent correlated factors affecting colorectal cancer patients’ survival after radical resection (all P<0.05). The NLR-CAR score had the largest area under the curve and higher prediction accuracy than NLR, CAR or NLR+CAR tests. ConclusionsThe NLR-CAR score is correlated to the prognosis of patients with colorectal cancer. It is a potential inflammation-based prognostic scoring index, which is superior to NLR or CAR alone.