术前炎症指标与直肠癌患者预后的关系及预后列线图预测模型的建立

Objective To compare the prognostic evaluation value of preoperative neutrophil-to- lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), andsystemic immune-inflammation index (SII) in rectal cancer patients. Nomogram survival prediction modelbased on inflammatory markers was constructed. Methods The clinical and survival data of 585 patientswith rectal cancer who underwent radical resection in the First Affiliated Hospital of Xi' an Jiao tongUniversity from January 2013 to December 2016 were retrospectively analyzed. The optimal cut-off values ofNLR, PLR, LMR, and SII were determined by the receiver operating characteristic ( ROC ) curve. Therelationship between different NLR, PLR, LMR and SII levels and the clinic pathological characteristics ofthe rectal cancer patients were compared. Cox proportional risk model was used for univariate andmultivariate regression analysis. Nomogram prediction models of overall survival ( OS ) and disease-freesurvival ( DFS) of patients with rectal cancer were established by the R Language software. The internalvalidation and accuracy of the nomograms were determined by the calculation of concordance index ( C- index) . Calibration curve was used to evaluate nomograms' efficiency. Results The optimal cut-off values ofpreoperative NLR, PLR, LMR and SII of OS for rectal cancer patients were 2.44,134.88,4.70 and 354.18,respectively. There was statistically significant difference in tumor differentiation degree between the low NLRgroup and the high NLR group ( P < 0. 05) , and there were statistically significant differences in T stage,N stage, TNM stage, tumor differentiation degree and preoperative carcinoembryonic antigen ( CEA) levelbetween the low PLR group and the high PLR group ( P<0.05) . There was statistically significant differencein tumor differentiation degree between the low LMR group and the high LMR group ( P < 0.05) , and therewere statistically significant differences in T stage, N stage, TNM stage, tumor differentiation degree andpreoperative CEA level between the low SII group and the high SII group ( P < 0. 05) . The multivariate Coxregression analysis showed that the age ( HR = 2.221, 95%CI: 1.526-3.231) , TNM stage ( - grade: HR =4.425, 95% CI: 1. 848-10. 596) , grade of differentiation ( HR = 1. 630, 95% CI: 1. 074-2. 474) , SII level( HR = 2.949, 95%CI: 1. 799-4. 835) , and postoperative chemoradiotherapy ( HR = 2. 123, 95% CI: 1. 506- 2.992) were independent risk factors for the OS of patients with rectal cancer. The age ( HR = 2.107, 95%CI: 1.535-2.893) , TNM stage (- grade, HR = 2.850, 95%CI: 1.430-5.680) , grade of differentiation ( HR =1.681, 95% CI: 1. 150-2. 457 ) , SII level ( HR = 2. 309, 95% CI: 1. 546-3. 447 ) , and postoperativechemoradiotherapy ( HR = 1.837, 95%CI: 1.369-2.464) were independent risk factors of the DFS of patientswith rectal cancer. According to the OS and DFS nomograms predict models of rectal cancer patientsestablished by multivariate COX regression analysis, the C-index were 0. 786 and 0. 746, respectively. Thecalibration curve of the nomograms showed high consistence of predict and actual curves . ConclusionsPreoperative NLR, PLR, LMR and SII levels are all correlated with the prognosis of rectal cancer patients,and the SII level is an independent prognostic risk factor for patients with rectal cancer. Preoperative SII levelcan complement with the age, TNM stage, differentiation degree and postoperative adjuvant chemoradiotherapy toaccurately predict the prognosis of rectal cancer patients, which can provide reference and help for clinicaldecision.