| Objective:In recent decades, with human development and rapid advancement of social life, substantial progress has been registered in people’s living standard. However, people’s dietary structure(especially the animal protein as the main source of nutrient uptake along with deep frying, roasting and barbecuing as cooking methods) has changed a great deal, thus digestive tract malignant tumor incidence rate showed an upward trend year after year. Colorectal cancer is the most common malignant tumor among digestive tract cancers, which is facing a serious situation in our country. Its incidence and morality rank third and fifth[1]respectively and both are increasing year by year. The decisive factors affecting the occurrence and development of colorectal cancer is more closely associated with the nutrition-supporting internal environment in which the tumor cells exist than with the genetic alterations in tumor cells. The micro environment where tumor inflammation interstitial substance exists can not only directly eliminate the infiltrated tumor cells, but also have a profound impact on the biological behaviors that may hinder prognosis such as adhesion, migration, proliferation, differentiation, invasion and metastasis of tumor cells. On the contrary, tumor inflammation interstitial substances are directly or indirectly regulated and influenced by tumor cell biological activity[2]. The body’s inflammatory environment of its internal environment plays an immeasurable role in tumor cell occurrence and development[3]. With the advancement of medical research, constant progress has been made in the study concerning the association between inflammatory markers with neutrophil-to-lymphocyte ratio(NLR) as the main observation object with colorectal cancer of each clinical stage as well as its prognosis[4]. The main purpose of this study is to explore the value of NLR in evaluating the prognosis of colorectal cancer patients and to evaluate the therapeutic effect at different levels in order to provide a theoretical basis to carry out individualized treatment and prolong the survival time of the patients.Method:The research object of this study is the patients who accept treatment in the first hospital of Qinhuangdao from October 1st 2006 to October 1st 2010, pathologically diagnosed with colorectal cancer with integral materials including treatment procedure, clinical data and follow-up data. This study shows there are 359 statistically qualified colorectal cancer patients, including 204 male and 155 female. In accordance with ROC curve, by taking both sensitivity and specificity into account and selecting the cut-off points with the highest Youden index(Youden index=sensitivity + specificity-1) as the critical point, this study takes NLR=2.54 value as the NLR cut-off point. Also, the concerned research object with colorectal cancer is divided into low NLR group and high NLR group. The purpose is to compare the differences between the two groups in terms of their clinical cases characteristics and prognosis of survival. Statistical basic characteristics data of the patients(include gender, age, tumor history, smoking history, drinking history, family history) and clinicopathologic feature data of the patients(include the white blood cell count before treatment, tumor location, tumor size, histological type(histology), degree of differentiation, synchronous liver metastasis, peritoneal implantation, lymphovascular invasion, infiltration depth(T), lymph node metastasis(N), distant metastasis(M), TNM stage(pathological staging applies to the American Joint Committee on Cancer AJCC Seventh Edition), carcinoembryonic antigen(CEA), sugar base antigen 199(CA-199) and varying treatment methods(radical resection, palliative surgery, chemotherapy) etc..). In view of the above-mentioned factors, we will statistically analyze low and high NLR groups respectively and discuss the relationship between NLR and various clinical factors. By following up the colorectal cancer patients we will determine their complete follow-up data and identify the patients’ overall survival(OS) and progression free survival(PFS). Finally, we will analyze the relationship between NLR value and colorectal cancer prognosis as well as survival.Results:Single factor analysis shows that age differences between low and high NLR group is statistically significant(P<0.05), compared with the differences in other basic characteristics(including gender, cancer history, smoking history, drinking history and family history), which is not statistically significant. In terms of clinical cases features(white blood cell count before treatment, tumor location, tumor size, lymph node metastasis(T) and TNM stage), differences between the two groups are statistically significant(P< 0.05); differences in other clinical case features(including pathological type(histology), differentiation, synchronous liver metastasis, peritoneal implantation, vasculartumor thrombus, depth of invasion(T), distant metastasis(M), CEA, CA-199) are not statistically significant. Low and high NLR group 1-year survival rate and 3- year survival rate is 99.53%, 87.41% and 78.70%, 61.53% respectively, low and high group 1-year and 3- year overall survival(OS) is 11.98, 11.44 months and 33.11, 27.99 months respectively. Both differences are statistically significant(P<0.05). The 3-year progression free survival(PFS) in patients with low NLR and high NLR is 23.21 months and 18.37 months respectively, and the difference is statistically significant(P< 0.05). Compared among different treatment methods of colorectal cancer, radical operation is found to make the 3-year survival rate of the patients in low NLR group significantly higher than that of patients in high NLR group(P<0.05). The difference in the 3-year survival rate between palliative surgery and chemotherapy is not statistically significant. Multivariate analysis verifies that NLR and TNM stage therapeutic methods are independent prognostic factors in patients with colorectal cancer.Conclusions:1 NLR is correlated with age, the white blood cell count before treatment, tumor location, tumor size, lymph node metastasis and TNM stage in prognostic factors of Colorectal Cancer.2 The fact that NLR before treatment is higher than 2.54 signifies that the prognosis for patients with colorectal cancer is poor, thus the level of NLR before treatment is probably a biological marker of high predictive value for the prognosis of colorectal cancer.3 NLR is an independent prognostic factor in colorectal cancer patients with OS. |
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