外周血淋巴细胞水平对血清CEA正常的结直肠癌患者的预后监测价值——淋巴细胞影响结直肠癌预后

Prognosis Value of Peripheral Lymphocytes Count in Colorectal Cancer Patients with Normal Serum CEA—Lymphocytes Predict Prognosis of Colorectal Cancer

摘要: 目的：探讨外周血常规指标对血清CEA水平正常的结直肠癌患者预后的监测价值。方法：收集广州医科大学附属肿瘤医院2015年1月至2018年12月收治的327例接受根治性手术的结直肠癌患者进行相关性和回归性分析。分析与血清CEA水平高低相关的临床资料，以及在血清CEA水平正常的结直肠癌患者中影响无复发生存期(Disease-free survival, DFS)的因素，筛选出血常规指标中该类患者临床预后有价值的监测指标。结果：血清CEA水平与结直肠癌患者的肿瘤分化程度(P = 0.047)、外周血中性粒细胞百分比(Neu%) (P = 0.022)、淋巴细胞百分比(Lym%) (P = 0.008)、淋巴细胞绝对值(Lym#) (P = 0.004)、中性粒细胞/淋巴细胞值(NLR) (P = 0.002)、淋巴细胞/单核细胞值(LMR) (P = 0.030)、血小板/淋巴细胞值(PLR) (P = 0.005)均有明显相关性。Logistic回归分析结果显示，外周血Lym# (P = 0.005)是血清CEA水平的独立影响因素(P < 0.05)。Cox回归分析结果显示，Lym# (P = 0.031)是影响血清CEA水平正常结直肠癌患者预后的独立因素(P < 0.05)。Lym# ≥ 1.805 × 109/L的患者DFS差于Lym < 1.805 × 109/L的患者(P = 0.016)。结论：外周血Lym#计数可用于评估血清CEA水平正常结直肠癌患者的临床预后。

Abstract: Objective: To investigate the prognosis value of routine blood indicators in colorectal cancer (CRC) patients with normal serum CEA level. Methods: A total of 327 patients with CRC and who received curative resection in the Affiliated Cancer Hospital of Guangzhou Medical University from January 2015 to December 2018 were analyzed by retrospective analysis. Relations of clinical data and different serum CEA levels were compared. Predictive factors of disease-free survival (DFS) in patients with normal serum CEA levels were analyzed, in order to select predictive marker(s) from routine blood test. Results: Serum CEA levels were revealed to relate to tumor differentiation (P = 0.047), percentage of peripheral neutrophils (Neu%) (P = 0.022), percentage of lymphocytes (Lym%) (P = 0.008), count of lymphocytes (Lym#) (P = 0.004), neutrophils to lymphocytes ratio (NLR) (P = 0.002), lymphocytes to monocytes ratio (LMR) (P = 0.030) and platelet to lymphocytes ratio (PLR) (P = 0.005). Logistic regression analysis showed Lym# was an independent impact factor of serum CEA level (P = 0.031). Cox regression analysis indicated that Lym# was an independent prognostic factor of DFS in patients with normal serum CEA level (P < 0.05). In the population of CRC with normal serum CEA, DFS of patients with Lym# ≥ 1.805 × 109/L was worse than that of patients with Lym# < 1.805 × 109/L (P = 0.016). Conclusions: Peripheral Lym# can be a useful prognostic predictor of CRC patients with normal serum CEA level.