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中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2024, Vol. 13 ›› Issue (05) : 682 -687. doi: 10.3877/cma.j.issn.2095-3232.2024.05.016

临床研究

术前外周血NLR和PLR对结肠癌术后肝转移的影响
何慧玲1, 鲁祖斌2, 冯嘉莉1, 梁声强1,†()   
  1. 1. 363000　福建省漳州市，厦门大学附属东南医院（第九〇九医院）检验科
    2. 363000　福建省漳州市，厦门大学附属东南医院（第九〇九医院）消化内科
  • 收稿日期:2024-05-20 出版日期:2024-10-10
  • 通信作者: 梁声强

Effect of preoperative peripheral blood NLR and PLR on postoperative colon cancer liver metastasis

Huiling He1, Zubin Lu2, Jiali Feng1, Shengqiang Liang1,†()   

  1. 1. Clinical Laboratory, Southeast Hospital Affiliated to Xiamen University (the 909th Hospital), Zhangzhou 363000, China
    2. Department of Gastroenterology, Southeast Hospital Affiliated to Xiamen University (the 909th Hospital), Zhangzhou 363000, China
  • Received:2024-05-20 Published:2024-10-10
  • Corresponding author: Shengqiang Liang
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引用本文：

何慧玲, 鲁祖斌, 冯嘉莉, 梁声强. 术前外周血NLR和PLR对结肠癌术后肝转移的影响[J]. 中华肝脏外科手术学电子杂志, 2024, 13(05): 682-687.

Huiling He, Zubin Lu, Jiali Feng, Shengqiang Liang. Effect of preoperative peripheral blood NLR and PLR on postoperative colon cancer liver metastasis[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2024, 13(05): 682-687.

目的

探讨结肠癌患者术前外周血中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）对术后肝转移的影响。

方法

回顾性分析2017年1月至2018年12月在厦门大学附属东南医院诊治的188例结肠癌患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男98例，女90例；年龄41～64岁，中位年龄52岁。根据术后随访1年内是否发生肝转移分为转移组（44例）和非转移组（144例）。以术前外周血NLR中位数2.4和PLR中位数216为临界值分为高NLR组、低NLR组和高PLR组、低PLR组。分析NLR、PLR与患者临床病理特征的关系，采用Logistic多因素回归分析结肠癌术后肝转移的影响因素，采用ROC分析NLR、PLR对结肠癌术后肝转移的预测效能。

结果

Logistic多因素分析显示，术前CEA≥5 μg/L（OR=3.480，95%CI：1.157～10.467）、浸润浆膜（OR=3.332，95%CI：1.151～9.646）、脉管侵犯（OR=4.857，95%CI：1.650～14.293）、术后未化疗（OR=4.370，95%CI：1.429～13.362）、NLR>2.4（OR=6.800，95%CI：2.048～22.573）、PLR>212（OR=8.546，95%CI：2.490～29.326）是结肠癌术后肝转移的独立影响因素（P<0.05）。NLR对结肠癌术后肝转移预测的ROC曲线下面积（AUC）为0.867（95%CI：0.779～0.937），敏感度为0.818，特异度为0.834；PLR对结肠癌术后肝转移预测的AUC为0.919（95%CI：0.868～0.969），敏感度为0.818，特异度为0.917；NLR联合PLR对结肠癌术后肝转移预测的AUC为0.922（95%CI：0.873～0.970），敏感度为0.841，特异度为0.903。

结论

术前NLR和PLR升高与结肠癌不良病理特征有关，NLR和PLR升高是结肠癌术后肝转移的独立影响因素，联合NLR和PLR对结肠癌术后肝转移有较好的预测效能。

关键词: 中性粒细胞与淋巴细胞比值, 血小板与淋巴细胞比值, 结肠肿瘤, 肿瘤转移, 影响因素, 预测
Objective

To evaluate the effect of neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) on postoperative liver metastasis in patients with colon cancer.

Methods

Clinical data of 188 patients with colon cancer admitted to Southeast Hospital Affiliated to Xiamen University from January 2017 to December 2018 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 98 patients were male and 90 female, aged from 41 to 64 years, with a median age of 52 years. All patients were divided into the metastasis (n=44) and non-metastasis groups (n=144) according to whether liver metastasis occurred within postoperative 1 year. According to the median cut-off values of preoperative NLR (2.4) and PLR (216), all patients were divided into the high and low NLR groups, and high and low PLR groups, respectively. The relationship between NLR and PLR and clinicopathological characteristics was analyzed. The influencing factors of postoperative colon cancer liver metastasis were identified by Logistic multivariate regression analysis. The predictive efficiency of NLR and PLR for postoperative colon cancer liver metastasis was assessed by the receiver operating characteristic (ROC) curve.

Results

Logistic multivariate analysis showed that CEA≥5 μg/L (OR=3.480, 95%CI: 1.157-10.467), serosa infiltration (OR=3.332, 95%CI: 1.151-9.646), vascular invasion (OR=4.857, 95%CI: 1.650-14.293), no postoperative chemotherapy (OR=4.370, 95%CI: 1.429-13.362), NLR>2.4 (OR=6.800, 95%CI: 2.048-22.573), PLR>212 (OR=8.546, 95%CI: 2.490-29.326) were the independent influencing factors of postoperative colon cancer liver metastasis (P<0.05). The area under the ROC curve (AUC) of NLR for predicting postoperative colon cancer liver metastasis was 0.867 (95%CI: 0.779-0.937), with a sensitivity of 0.818 and a specificity of 0.834. The AUC, sensitivity and specificity of PLR in predicting postoperative colon cancer liver metastasis were 0.919 (95%CI: 0.868-0.969), 0.818 and 0.917, respectively. The AUC of NLR combined with PLR in predicting postoperative colon cancer liver metastasis was 0.922 (95%CI: 0.873-0.970), the sensitivity was 0.841, and the specificity was 0.903, respectively.

Conclusions

The increase of preoperative NLR and PLR in colon cancer are associated with adverse pathological characteristics. High NLR and PLR are the independent influencing factors of postoperative colon cancer liver metastasis. The combination of NLR and PLR yields high predictive efficiency for postoperative colon cancer liver metastasis.

Key words: Neutrophil to lymphocyte ratio, Platelet to lymphocyte ratio, Colon neoplasms, Neoplasm metastasis, Influencing factors, Forecast
表1 术前NLR与结肠癌患者临床病理特征的关系（例）
参数 例数 NLR>2.4 NLR≤2.4 χ2值 P值
年龄≥55岁 87 49 38 3.043 0.081
性别男 98 47 51 0.186 0.666
左半结肠癌 76 31 45 3.844 0.050
腹腔镜手术 92 46 46 0.020 0.886
术前CEA≥5 μg/L 70 43 27 6.382 0.012
肿瘤直径≥5 cm 57 37 20 7.806 0.005
浸润浆膜 54 34 20 5.519 0.019
生长类型       1.425 0.051
隆起型 80 41 39    
溃疡型 82 37 45    
浸润型 26 15 11    
腺癌 92 41 51 1.733 0.188
低分化 77 40 37 0.321 0.571
淋巴结转移 71 42 29 4.283 0.039
脉管侵犯 64 39 25 5.106 0.024
TNM分期       5.246 0.022
Ⅰ～Ⅱ期 128 56 72    
Ⅲ～Ⅳ期 60 37 23    
肝转移 44 39 5 35.255 <0.001
表2 术前PLR与结肠癌患者临床病理特征的关系（例）
参数 例数 PLR>216 PLR≤216 χ2值 P值
年龄≥55岁 87 42 45 0.092 0.762
性别男 98 47 51 0.186 0.666
左半结肠癌 76 35 41 0.595 0.440
腹腔镜手术 92 46 46 0.020 0.886
术前CEA≥5 μg/L 70 45 25 9.796 0.002
肿瘤直径≥5 cm 57 38 19 9.680 0.002
浸润浆膜 54 32 22 2.906 0.088
生长类型       7.367 0.025
隆起型 80 34 46    
溃疡型 82 40 42    
浸润型 26 19 7    
腺癌 92 48 44 0.528 0.468
低分化 77 40 37 0.321 0.571
淋巴结转移 71 40 31 2.154 0.142
脉管侵犯 64 40 24 6.592 0.010
TNM分期       6.777 0.009
Ⅰ～Ⅱ期 128 55 73    
Ⅲ～Ⅳ期 60 38 22    
肝转移 44 40 4 39.466 <0.001
表3 结肠癌患者术后肝转移单因素分析（例）
因素 转移组 非转移组 χ2值 P值
术前CEA≥5 μg/L 29 41 20.211 <0.001
肿瘤直径≥5 cm 25 32 19.093 <0.001
浸润浆膜 21 33 10.133 0.001
淋巴结转移 26 45 11.115 0.001
脉管侵犯 25 39 13.271 <0.001
TNM分期Ⅲ～Ⅳ期 23 37 10.956 0.001
术后未化疗 21 40 6.119 0.013
表4 结肠癌患者术后肝转移Logistic多因素分析
因素 b SE（b） Wald χ2 OR 95%CI P
术前CEA≥5 μg/L 1.247 0.562 4.926 3.480 1.157～10.467 0.026
肿瘤直径≥5 cm 0.851 0.555 2.348 2.342 0.789～6.956 0.125
浸润浆膜 1.203 0.542 4.923 3.332 1.151～9.646 0.027
淋巴结转移 0.941 0.534 3.109 2.563 0.900～7.298 0.078
脉管侵犯 1.580 0.551 8.234 4.857 1.650～14.293 0.004
TNM分期Ⅲ～Ⅳ期 0.411 0.559 0.542 1.509 0.505～4.511 0.462
术后未化疗 1.475 0.570 6.691 4.370 1.429～13.362 0.010
NLR>2.4 1.917 0.612 9.084 6.800 2.048～22.573 0.002
PLR>216 2.145 0.629 11.630 8.546 2.490～29.326 0.001
图1 术前NLR、PLR对结肠癌患者术后肝转移预测的ROC曲线注：NLR为中性粒细胞与淋巴细胞比值，PLR为血小板与淋巴细胞比值
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