The Prognostic Value Of Neutrophil-to-lymphocyte Ratio(NLR)、centre Tumor CD3+ And CD8+ T Cells In Patients With Colorectal Cancer

Part I.Objective:To explore the role of combined detection of carcinoembryonic antigen(CEA)and neutrophil-to-lymphocyte ratio(NLR)in the prognostic assessment of colorectal cancer(CRC).Methods:We investigated preoperative NLR and CEA in 125 surgical CRC patients,determined the patients’ thresholds by receiver operating characteristic(ROC)curve analysis,and assessed their prognostic values by Kaplan-Meier curve,COX regression models.In addition,we used nomograms of several risk factors to evaluate the risk in survival and predictive accuracy by using Harrell’s concordance index(c-index).Results:Results of multivariate analysis showed high NLR,high CEA and high COCN(combination of CEA and NLR)were significantly correlated with decreased disease-free survival(DFS),[HR:2.229,95%CI:1.012-4.911,P=0.047;HR:3.652,95%CI:1.630-8.179,P=0.002;HR:3.139,95%CI:1.800-5.472,P<0.001].But,high CEA and COCN remained significant only for decreased overall survival(OS),[HR:3.713,95%Cl:1.396-9.873,P=0.009;HR:3.106;95%CI:1.576-6.123,P=0.001].High NLR showed higher mortality rates with worse OS(p=0.058),and nomograms containing NLR improved the predictive accuracy.Area under the curve of COCN was higher than that of CEA or NLR.Conclusion:COCN acts as a better independent prognostic biomarker of CRC than NLR or CEA alone.Part Ⅱ.Objective:To explore the role of Immunoscore(IS),a combinatorial density analysis of CD8+T and CD3+T cells in the centre and invasive margin of tumour(named ct and im),in the prognostic assessment of colorectal cancer(CRC).Methods:We investigated the numbers of CD3+T or CD8+ T cells in ct and im in 53 surgical CRC patients,determined the relationship and assessed their prognostic values of CD3+T or CD8+T cells and all clinical pathological variables by Kaplan-Meier curve,COX regression models.Results:The distribution and density of CD3+T or CD8+T cells varied in different CRC areas.CD3+T or CD8+T cells in ct area were higher than that in im area.High CD3+T cells in ct area、TNM and N were significantly correlated with Overall survival(OS)and decreased disease-free survival(DFS),But,high CD3+T cells in ct remained significant only for decreased DFS and an independent prognostic factor and Combined detection of IS and TNM showed a strong relationship with lower DFS(HR:0.855,95%CI:0.465-1.571,P=0.045).Meanwhile,there were no relationships between CEA or CA199 for OS or DFS.Conclusion:CD3+T cells in ct act as a good prognostic factor in nonmetastatic patients undergoing colorectal cancer resection.