术前癌胚抗原联合单核细胞/淋巴细胞比值、 乳酸脱氢酶/白蛋白比值在结直肠癌手术 患者远期生存预后中的价值

The Value of Preoperative Carcinoembryonic Antigen Combined with Monocyte-to-Lymphocyte Ratio and Lactate Dehydrogenase-to-Albumin Ratio in Long-Term Survival Prognosis of Colorectal Cancer Surgical Patients

摘要: 目的：探讨术前血清癌胚抗原(CEA)联合单核细胞/淋巴细胞比值(MLR)、乳酸脱氢酶/白蛋白比值(LAR)对可切除结直肠癌(CRC)患者预后的预测价值。方法：回顾性分析2019年1月至2020年3月于重庆医科大学附属第一医院接受根治性手术的216例CRC患者资料。通过ROC曲线确定CEA、MLR、LAR的最佳截断值。根据截断值分组后，采用Kaplan-Meier法、Log-rank检验比较5年总生存期(OS)，通过单因素与多因素Cox比例风险回归模型分析独立预后因素，并构建CEA-MLR-LAR联合评分系统(0~3分)，评估其对OS的预测效能。结果：在单因素分析中发现年龄、高血压、CA199、TNM分期、淋巴结转移情况、CEA、MLR、LAR与OS显著相关(P < 0.05)；在多因素分析中发现CEA (HR = 1.014, P = 0.001)、MLR (HR = 5.919, P = 0.024)、LAR (HR = 1.040, P = 0.013)及TNM分期(HR = 4.629, P < 0.001)为独立预后因素；CEA、MLR、LAR的最佳截断值分别为4.06 ng/mL、0.30、4.47。生存分析显示高CEA (≥4.06 ng/mL)、高LAR (≥4.47)、高MLR (≥0.30)组OS显著较差(P < 0.001)；CEA-LAR-MLR联合指标评分高组(2~3分)相较于低分组(0~1分)死亡风险显著增加(P < 0.001)，联合指标预测5年死亡风险AUC值为0.790 (95% CI: 0.714~0.866)，优于任一单独指标(CEA: 0.695, MLR: 0.682, LAR: 0.672)。结论：术前CEA、MLR、LAR是CRC患者术后5年OS的独立预测因子，三者联合可显著提升预后预测效能，为个体化治疗决策提供依据。

Abstract: Objective: To explore the predictive value of preoperative serum carcinoembryonic antigen (CEA) in conjunction with the monocyte-to-lymphocyte ratio (MLR) and the lactate dehydrogenase-to-albumin ratio (LAR) for assessing the prognosis of patients with resectable colorectal cancer (CRC). Methods: A retrospective analysis was conducted on the data of 216 CRC patients who underwent radical surgery at The First Affiliated Hospital of Chongqing Medical University from January 2019 to March 2020. The optimal cutoff values for CEA, MLR, and LAR were determined through ROC curve analysis. After grouping based on the cutoff value, the Kaplan-Meier method and the Log-rank test were utilized to compare the 5-year overall survival (OS) rates. Univariate and multivariate Cox proportional hazards regression models were employed to analyze independent prognostic factors. A combined scoring system, CEA-MLR-LAR, was constructed, with a scoring range of 0 to 3 points, to evaluate its predictive efficacy for OS. Results: In the univariate analysis, age, hypertension, CA199 levels, TNM stage, lymph node metastasis, CEA levels, MLR, and LAR were significantly associated with OS (P < 0.05). In the multivariate analysis, CEA (HR = 1.014, P = 0.001), MLR (HR = 5.919, P = 0.024), LAR (HR = 1.040, P = 0.013), and TNM stage (HR = 4.629, P < 0.001) were identified as independent prognostic factors. The optimal cutoff values for CEA, MLR, and LAR were determined to be 4.06 ng/mL, 0.30, and 4.47, respectively. Survival analysis indicated that groups with high CEA (≥4.06 ng/mL), high LAR (≥4.47), and high MLR (≥0.30) exhibited significantly worse OS (P < 0.001). Furthermore, the high CEA-LAR-MLR combined index score group (2~3 points) demonstrated a significantly increased risk of death compared to the low score group (0~1 points) (P < 0.001). The combined index effectively predicted the 5-year risk of death, yielding an AUC value of 0.790 (95% CI: 0.714~0.866), surpassing the predictive capabilities of any single index (CEA: 0.695, MLR: 0.682, LAR: 0.672). Conclusions: Preoperative CEA, MLR, and LAR are independent predictors of 5-year OS in CRC patients. Their combined use significantly enhances the predictive efficacy for prognosis, thereby providing a foundation for individualized treatment decisions.