目的 探讨术前中性粒细胞/ 淋巴细胞比值(NLR)和癌胚抗原(CEA)对同时性结直肠癌肝转移患者的预后价值。 方法 回顾性收集 2012 年 8 月至 2017 年 12 月期间在河北北方学院附属第一医院行同期肝切除的同时性结直肠癌肝转移患者 的临床病理资料,使用 X-TILE 软件来计算 NLR 的最佳截止点;采用 Kaplan-Meier 生存曲线和 Log-rank 检验来绘制和比较生 存曲线,利用 Cox 比例风险回归模型来分析独立预后因素;采用时间依赖性曲线下面积( t-AUC)来绘制和比较不同指标联合 使用时的预后价值。 结果 共有 122 例同时性结直肠癌肝转移患者被纳入此研究,NLR 进行预后分层时的最佳截止点为 2. 1,术前较高的 NLR 和更高的病理 T 分期相关(P= 0. 037),但与低 NLR 组相比在其他指标上均无明显差异(P>0. 05);单因 素生存分析提示术前 NLR 水平、最大肝转移直径、结直肠癌 pT 分期、是否淋巴结转移和术前 CEA 水平与同时性结直肠癌肝 转移患者的预后相关(P 均<0. 05);多因素生存分析肝转移数目(HR = 1. 644,95%CI = 1. 063 ~ 2. 542,P = 0. 025)、有淋巴结转 移(HR= 1. 76,95%CI = 1. 045~ 2. 965,P= 0. 034)、CEA≥3. 4 μg / L(HR= 1. 611,95%CI = 1. 054 ~ 2. 460,P = 0. 028),以及 NLR≥ 2. 1(HR= 1. 625,95%CI = 1. 044~ 2. 539,P= 0. 033)是同时性结直肠癌肝转移患者预后的独立危险因素。 NLR 在预测患者预后 时的 t-AUC 为 60. 89% ~ 66. 41%,CEA 为 58. 15% ~ 66. 41%,联合检测时的 t-AUC 为 64. 53% ~ 68. 36%,CEA 在预测患者预后 时的 C-index 为 0. 648(95%CI = 0. 543~ 0. 752),NLR 为 0. 688(95%CI = 0. 583 ~ 0. 795),二者相比无明显差异(P = 0. 29),联 合检测时 C-index 可提高到 0. 69(95%CI = 0. 586~ 0. 795),但对比单独使用 CEA(P = 0. 12)或 NLR(P = 0. 52)时均无统计学 差异。 结论 术前 NLR 或 CEA 升高与同时性结直肠癌肝转移患者的不良预后密切相关,联合应用术前 NLR 和 CEA 可提高对 患者预后预测的准确性。

Objective To investigate the prognostic value of preoperative neutrophil - to - lymphocyte ratio NLR and carcinoembryonic antigen CEA in patients with concurrent colorectal cancer liver metastases. Method The clinicopathological data of patients with concurrent colorectal cancer liver metastases who underwent liver resection in our hospital from August 2012 to December 2017 were retrospectively analyzed and X-TILE software was used to calculate the best cut-off value of NLR. Kaplan-Meier method and Log-rank test were used to draw and compare different survival curves and COX proportional hazards regression model was used to analyze independent prognostic factors. The time dependent area under ROC curve t - AUC is used to draw and compare the prognostic value of different indicators also in combination. Result A total of 122 patients with concurrent liver metastases from colorectal cancer were included in this study. After calculation the best cut-off value for NLR for prognostic stratification is 2. 1. The preoperative higher NLR was correlated with higher pathological T staging P= 0. 037 but compared with the low NLR group there was no significant difference in other indicators all P > 0. 05 . Univariate survival analysis showed that preoperative NLR level maximum liver metastasis diameter colorectal cancer pT stage lymph node metastasis and preoperative CEA level were correlated with the prognosis of patients with concurrent colorectal cancer liver metastasis all P<0. 05 multivariate Survival analysis the number of liver metastases HR= 1. 644 95%CI = 1. 063-2. 542 P= 0. 025 lymph node metastases HR= 1. 76 95%CI = 1. 045-2. 965 P = 0. 034 CEA≥3. 4 μg / L HR= 1. 611 95%CI = 1. 054-2. 460 P= 0. 028 and NLR≥2. 1 HR= 1. 625 95%CI = 1. 044-2. 539 P= 0. 033 are the prognosis of patients with liver metastases from concurrent colorectal cancer Independent risk factors. When NLR ·80· 肿瘤代谢与营养电子杂志 2023 年 2 月 9 日第 10 卷第 1 期 Electron J Metab Nutr Cancer, Feb. 9, 2023, Vol. 10, No. 1 predicts patient prognosis t-AUC is 60. 89% ~ 66. 41% CEA is 58. 15%-66. 41% and t-AUC is 64. 53%-68. 36% when the two indicates are combined. In addition the C-index of CEA in predicting the prognosis of patients was 0. 648 95%CI = 0. 543-0. 752 and the NLR was 0. 688 95%CI = 0. 583-0. 795 . There was no significant difference between the two indicates P = 0. 29 . When combination CEA and NLR to predict the prognosis the C-index could be increased to 0. 69 95%CI = 0. 586-0. 795 . However there was no statistical difference when compared with CEA P = 0. 12 or NLR P = 0. 52 alone respectively. Conclusion The elevate of preoperative NLR or CEA is closely related to the poor prognosis of patients with concurrent colorectal cancer liver metastases. The combined use of preoperative NLR and CEA can improve the accuracy of predicting the prognosis of patients.