临床肿瘤学杂志

目的 探讨化疗前外周血中性粒细胞与淋巴细胞比值(NLR)对不可切除转移性结直肠癌(mCRC)患者接受一线化疗后生存预后的影响。方法 选取接受一线化疗的198例mCRC患者为研究对象，并根据患者化疗前外周血NLR的中位值将其分为低NLR组(<2.81,n=99)组和高NLR组(≥2.81,n=99)。采用χ²检验比较两组患者的临床病理特征，采用Kaplan-Meier法绘制生存曲线，Log-rank检验比较两组患者的生存情况。采用Cox比例风险回归模型分析患者总生存时间(OS)的影响因素。结果 低NLR组和高NLR组患者在年龄、性别、肿瘤部位、肿瘤大小、分化程度、ECOG评分、癌胚抗原(CEA)及糖类抗原199(CA199)水平间的差异无统计学意义(P>0.05)。单因素Cox回归分析显示，分化程度(HR=1.837,95%CI:1.197～2.819,P=0.005)、ECOG评分(HR=4.267,95%CI:3.033～6.003,P<0.001)、CA199(HR=1.619,95%CI:1.193～2.198,P=0.002)及NLR(HR=1.436,95%CI:1.061～1.945,P=0.019)均与mCRC患者的OS显著相关。多因素Cox回归分析结果显示，分化程度(HR=2.089,95%CI:1.351～3.231,P=0.001)、ECOG评分(HR=4.264,95%CI:3.002～6.057,P<0.001)、CA199(HR=1.381,95%CI:1.009～1.889,P=0.044)及NLR(HR=1.390,95%CI:1.023～1.887,P=0.035)均为影响mCRC患者OS的独立预后因素。Kaplan-Meier生存分析显示，高NLR组患者的5年生存率为7.07%,而低NLR组为21.21%,两组差异有统计学意义(P=0.013)。结论 化疗前较高的NLR是不可切除mCRC患者的一个不良预后因素。因此，NLR可作为评估该类患者预后的有效参考指标。

Objective To investigate the significance of pre-chemotherapy peripheral blood neutrophil-to-lymphocyte ratio(NLR) in patients diagnosed with unresectable metastatic colorectal cancer(mCRC) who are undergoing first-line chemotherapy. Methods A total of 198 mCRC patients undergoing initial chemotherapy were chosen as the subjects of the study and were stratified into two groups based on their NLR levels before treatment: a low NLR group(<2.81, n=99) and a high NLR group(≥2.81, n=99) using the median value as the cutoff point. The χ² test was used to analyze and compare the clinicopathological characteristics of the two groups of patients, the Kaplan-Meier method was used to draw the survival curves, the Log-rank test was used to compare the survival of the two groups of patients and the Cox proportional risk regression model was used to analyze the factors affecting the overall survival time(OS) of the patients. Results There were no significant differences in baseline clinicopathological characteristics, including age, sex, tumor location, tumor size, histological differentiation, ECOG performance status, CEA and CA199 levels between the low NLR group and the high NLR group(all P>0.05). Univariate Cox regression analysis identified histological differentiation(HR=1.837, 95% CI: 1.197-2.819, P=0.005), ECOG performance status(HR=4.267, 95% CI: 3.033-6.003, P<0.001), CA199(HR=1.619, 95% CI: 1.193-2.198, P=0.002), and NLR(HR=1.436, 95% CI: 1.061-1.945, P=0.019)were all significantly associated with OS in mCRC patients. Multivariate Cox regression confirmed that histological differentiation(HR=2.089, 95% CI: 1.351-3.231, P=0.001), ECOG performance status(HR=4.264, 95% CI: 3.002-6.057, P<0.001), CA199(HR=1.381, 95% CI: 1.009-1.889, P=0.044) and NLR(HR=1.390, 95% CI: 1.023-1.887, P=0.035) were independent prognostic factors for OS in patients with mCRC. Kaplan-Meier survival analysis demonstrated that patients in the high NLR group had a significantly lower 5-year survival rate(7.07%) compared to the low NLR group(21.21%), and the differences were statistically significant(P=0.013). Conclusion The presence of a higher peripheral blood NLR prior to chemotherapy is indicative of an unfavorable prognosis and can serve as a valuable prognostic marker for patients with unresectable mCRC.