结直肠癌远处转移患者治疗前LMR 值与化疗疗效和死亡风险的相关性研究

Prognostic value of LMR on patients with distant metastasis of colorectal cancer prior to therapeutic interventions

摘要:

目的 探讨结直肠癌远处转移患者治疗前淋巴细胞/ 单核细胞比值（LMR）与化疗疗效和死亡风险的相关性研究。方法 回顾性分析95 例结直肠癌远处转移患者的临床资料，计算所有患者LMR 值。通过受试者工作特征曲线（ROC）预测模型分析治疗前LMR 值对化疗疗效的预测价值，作Excel 散点图明确治疗前LMR 值与无进展生存期及总生存期之间相关性。利用Cox 回归方程分析治疗前LMR 值对死亡风险的预测作用。结果95 例患者的化疗结果为完全缓解2 例（2.4%）、部分缓解28 例（29.47%）、病情稳定45 例（47.37%）及病情进展20 例（21.05%）。LMR 对化疗疗效ROC 预测模型的AUC 为0.950，95%CI ：（0.906，0.995），LMR 临界值5.565，敏感性0.932、特异性0.952。随着LMR 值增大，患者无进展生存时间与总生存时间均延长，呈正相关。LMR 与无进展生存期及总生存期的线性方程分别为（y =0.3978x +13.191，y =0.3693x +19.367）。至末次随访，高LMR 患者的生存率为40.63%（26/64），低LMR 患者的生存率为3.23%（1/31），差异有统计学意义（χ2=14.359，P =0.000）。不同LMR 分组的Cox 回归分析结果显示，结直肠癌远处转移患者的治疗前LMR 对死亡风险有一定预测作用，LMR 值越高死亡风险越小。结论 结直肠癌远处转移患者的治疗前LMR 值与化疗疗效、生存期相关，对化疗疗效及死亡风险具有良好预测作用。

Abstract:

Objective To investigate the prognostic value of LMR on patients with distant metastasis of colorectal cancer prior to therapeutic interventions and potential association between them. Methods A total of 95 patients diagnosed with colorectal cancer accompanied by distant metastasis were included in this study. LMR value of all patients were recorded before any treatments. ROC prediction model was established for correlation analysis between LMR and progression-free survival and overall survival. The Cox regression equation was utilized to identify the predictive effect of LMR on overall outcome. Results Among 95 cases, chemotherapy resulted in 2 cases of complete remission (2.4%), 28 cases of partial remission (29.47%), 45 cases in stable status (47.37%), and 20 cases in progressive disease (21.05%). The AUC of the LMR versus chemotherapy efficacy in ROC model was 0.950 (95% CI: 0.906, 0.995). Threshold of LMR was 5.565 with sensitivity as 0.932 and specificity as 0.952. Progressionfree survival and total survival were positively associated with increase of LMR. The linear equations of LMR over progression-free survival and total survival were (y = 0.3978x+13.191) and (y = 0.3693x+19.367), respectively. Based on data from follow-up, the survival rate in group of patients with high LMR increased dramatically when compared with patients with low LMR (40.63% vs 3.23%, P = 0.000). Cox regression analysis showed that low value of LMR could be an independent risk factor of colorectal cancer. Conclusion LMR value in colorectal cancer patients with distant metastasis prior to any treatments may be positively associated with chemotherapy efficacy and clinical outcomes.