常规临床检验指标与结直肠癌临床病理参数的关联分析及诊断预测价值

目的探讨常规临床检验指标(血细胞炎性指标和血清肿瘤标志物)与结直肠癌(CRC)患者临床病理参数的相关性,并建立诊断预测CRC的列线图。方法回顾性分析370例初诊CRC患者临床资料,统计分析常规临床检验指标与CRC患者临床病理参数的关系及其诊断效能,通过多因素Logistic回归分析确定CRC的独立危险因素,建立用于诊断预测的Nomogram模型,评价其预测效能。结果与体检健康者相比,CRC患者中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)、红细胞分布宽度(RDW)水平明显增高,淋巴细胞与单核细胞比值(LMR)水平明显减低(P均<0.01)。NLR与肿瘤大小、T分期、TNM分期、淋巴结转移和远处转移相关,PLR与性别、肿瘤部位、T分期和淋巴结侵犯有关。上述4项血细胞炎性指标联合血清肿瘤标志物(CEA和CA19-9)的AUC^ROC达0.844,敏感性为67.1%,特异性为87.9%。除NLR外的其他5项临床检验指标与年龄、性别均是CRC的独立危险因素(P均<0.05),以此建立的Nomogram模型的C指数为0.866。结论NLR、LMR、PLR、RDW和CEA、CA19-9间相互联合有助于CRC早期筛查,建立的预测模型具有一定的临床价值。

Predictive value of routine clinical test indicators in the diagnosis of colorectal cancer (CRC) and their correlation with clinicopathological parameters of CRC

Objective To investigate the correlation of routine clinical test indicators,including routine blood test indicators and serum tumor markers,with clinicopathological parameters of colorectal cancer(CRC),and establish a nomogram for the diagnosis and prediction of CRC.Methods The clinical data from 370 patients with newly diagnosed CRC were retrospectively analyzed.The correlation of routine clinical test indicators with clinicopathological parameters of CRC patients and their diagnostic efficacy were statistically analyzed.The independent risk factors of CRC were determined by the multivariate Logistic regression analysis.Then,the nomogram model for the diagnosis and prediction of CRC was established and its predictive efficiency was evaluated.Results The neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR)and red blood cell distribution width(RDW)in the patients with CRC were significantly higher than those of healthy controls,while the lymphocyte-to-monocyte ratio(LMR)significantly lower(all P<0.01).NLR was related to tumor size,T staging,TNM staging,lymph node metastasis and distant metastasis,while PLR was related to sex,tumor location,T staging and lymph node invasion.The AUC^ROC,sensitivity and specificity of NLR,PLR,RDW and LMR combined with serum tumor markers such as CEA and CA19-9 for the diagnosis of CRC were 0.844,67.1%and 87.9%,respectively.PLR,RDW,LMR,CEA,CA19-9,age and sex were the independent risk factors of CRC(all P<0.05),and the C-index of the established nomogram model based on these indicators was 0.866.Conclusion The combination of NLR,LMR,PLR,RDW,CEA and CA19-9 is helpful for the early screening of CRC,and the established prediction model has a certain clinical value in the diagnosis of CRC.