文章摘要
崔婧雯,李袁飞.肿瘤免疫评分联合中性粒细胞与淋巴细胞比值、血小板与淋巴细胞比值对结肠癌术后预后的价值研究[J].安徽医药,2024,28(7):1381-1387.
肿瘤免疫评分联合中性粒细胞与淋巴细胞比值、血小板与淋巴细胞比值对结肠癌术后预后的价值研究
Postoperative prognosis value of tumor immunoscore and NLR, PLR of colon cancer
  
DOI:10.3969/j.issn.1009-6469.2024.07.024
中文关键词: 结肠肿瘤  肿瘤免疫评分  中性粒细胞与淋巴细胞比值  血小板与淋巴细胞比值  预后
英文关键词: Colonic neoplasms  Tumor immunoscore  Neutrophil-to-lymphocyte(NLR)  Platelet-to-lymphocyte(PLR)  Prognosis
基金项目:山西省省筹资金资助回国留学人员科研项目( 2020-171);山西省人社厅留学办科研活动择优资助项目( 1176)
作者单位E-mail
崔婧雯 山西医科大学第一医院肿瘤科山西太原 030001  
李袁飞 山西医科大学第一医院肿瘤科山西太原 030001 liyflinda@163.com 
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中文摘要:
      目的探究免疫评分( IS)单独及联合外周血炎症标志物对结肠癌病人术后预后的预测价值。方法以 2013年 1月至 2019年 12月在山西医科大学第一医院接受结肠癌根治术 81例为研究对象,进行为期 5年的跟踪随访。收集病人所有的临床病理资料,并通过免疫组化对所有病人术后病理标本进行免疫评分。行 χ2检验、 Kaplan-Meier生存分析、 Cox回归、构建列线图(nomogram)模型和时间依赖的受试者操作特征曲线( tROC曲线)等分析比较临床病理因素、免疫评分、外周血炎症标志物等与病人总生存期( OS)和无病生存期( DFS)的关系。结果生存分析结果显示,高免疫评分水平与病人的 TNM分期( 38例Ⅰ~Ⅱ期, 43例Ⅲ~Ⅳ期, P=0.006)、术前糖类抗原 199(64例 CA199≤35 μg/L,17例 CA199>35 μg/L,P=0.038)有关。免疫评分( IS≥3比 IS<3)、中性粒细胞与淋巴细胞比值( NLR≤2.82比 NLR>2.82)、血小板与淋巴细胞比值( PLR≤113.15比 PLR>113.15)、术前糖类抗原 199(CA199)(CA199≤35 μg/L比 CA199>35 μg/L)是病人的独立预后因素。将有预后价值的变量整合,建立 OS和 DFS的列线图预测模型,模型 C指数为 0.79和 0.76,校准曲线均表现出良好的一致性。 tROC曲线也证明了该列线图模型预测结肠癌术后的预后价值高于单一指标和传统的 TNM分期系统,其曲线下面积( AUC)分别为 0.88(3年 OS)、 0.85(5年 OS)、 0.84(3年 DFS)、 0.82(5年 DFS)。结论免疫评分联合 NLR、PLR、CA199对结肠癌病人术后预后有较高的预测价值,可为结肠癌预后判断及治疗方案的选择提供依据,值得临床推广应用。
英文摘要:
      Objective To explore the predictive value of immunoscore (IS) alone or in combination with peripheral inflammatorymarkers for postoperative prognosis of patients with colon cancer.Methods 81 cases of colon cancer, who underwent radical resectionin The First Hospital of Shanxi Medical University from January 2013 to Decemember 2019, were selected as research objects and followed up for 5 years after surgery.The clinicopathological data of all patients were collected, and immunohistochemistry (IHC) was usedto calculate the IS of postoperative pathological specimens.Chi-square test,Kaplan-Meier estimates,Cox proportional hazard regression analyses,nomogram model and time-dependent receiver operating characteristic (tROC) curve were performed to analyse the correlationbetween clinicopathological features, IS, peripheral inflammatory markers and overall survival (OS) and disease free survival (DFS) ofpatients.Results Survival analysis results showed that high IS was related with TNM staging (38 cases of StageⅠ-Ⅱ,43 cases of Stage Ⅲ-Ⅳ, P=0.006) and preoperative carbohydrate antigen 199 (CA 199) (CA 199 of 64 cases ≤35 μg/L, CA 199 of 17 cases >35 μg/L, P= 0.038). IS(IS≥3 vs. IS<3), neutrophil to lymphocyte ratio (NLR≤2.82 vs. NLR>2.82),platelet to lymphocyte ratio (PLR≤113.15 vs. PLR> 113.15) and CA 199 (CA 199≤35 μg/L vs. CA 199>35 μg/L) were independent prognostic factors for patients. The above parameterswith prognostic value were integrated to construct the nomogram for OS and DFS. The concordance indexes (C-index) of the nomogramwere 0.79 and 0.76, and calibration curves displayed high accordance with actual observed values. tROC also confirmed that the nomogram had higher significance in predicting the prognostic value than a single marker or traditional TNM staging, with AUC values of 0.88 (3-year OS), 0.85 (5-year OS), 0.84 (3-year DFS), and 0.82 (5-year DFS).Conclusion Tumor immunoscore in combination with NLR, PLR, and CA 199 has a high predictive value for the prognosis of patients with colon cancer, which can provide support for theprognostic evaluation and clinical treatment and is worthy of application in clinical practice.
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