| Background and Objective:Malignant tumors of the digestive system in the worldwide,the incidence of colorectal cancer is extremely high,the mortality rate is also high.Early studies have confirmed the value of CEA in predicting prognosis,assisted staging and follow-up in colorectal cancer.Although CA199 has been widely used in colorectal cancer,its value in assisted staging and predictive prognosis and other aspects of the value are differences in colorectal cancer.In recent years,studies have found that inflammation plays a key role in the occurrence and metastasis of various tumors in domestic and abroad,the neutrophil-to-lymphocyte ratio(NLR)was confirmed to be an alternative marker of inflammatory response,has been reported in many literatures is closely related to the diagnosis,staging and prognosis in colorectal cancer.This study will further explore the relationship between CEA,CA199 as well as NLR and Ⅱ,Ⅲcolorectal cancer patients,in order to provide a more scientific clinical basis and theoretical basis for the accurate diagnosis and treatment and follow-up monitoring of colorectal cancer patients.Methods:1.Subjects:Retrospective analysis of a total of 144 patients who underwent radical resection and confirmed by histopathology at stage Ⅱ and Ⅲ colorectal cancer were enrolled in this study from November 20,2001 to November 20,2011 in our hospital,to collecting its complete clinical pathological parameters and follow-up datas,and performing statistical and analysis.2.Serum samples were collected(1)The tumor markers carcinoembryonic antigen(CEA)and Sugar chain antigen 199(CA199)were collected within 1 week before surgery and within 1 month after surgery before chemoradiotherapy,the serum markers neutrophil count(N)and lymphocyte count(L)were collected at the same time,the value of NLR was obtained by dividing the neutrophil count by the lymphocyte count.All laboratory indicators were measured within 1 week before surgery and within 1 month after surgery did not receive chemoradiotherapy,without the use of ascending white blood cell drugs or other immune drugs,all patients were no acute and chronic inflammation,acute injury,blood and immune-related diseases.(2)The reference range is set as follows according to our hospital:CEA<5.0ng/ml is defined as normal,CA199<27.0U/ml is defined as normal,the reference range of the normal value of neutrophil count was(2.0-7.0)× 109/L,and the reference range of the normal value of lymphocyte count was(0.8-4.0)× 10-/L.3.Follow upAll patients were followed up by electronic medical record or telephone,the follow-up period ended at November 20,2016.Disease-free survival(DFS)is defined as the time from the date of surgery to disease local recurrence,distant metastasis or death due to any cause.Overall survival(OS)is defined as the time from the date of surgery to any cause of death or the last follow-up date.4.Statistical methodStatistical analysis was performed using the SPSS 20.0 software version.The area under the curve(AUC)was calculated by plotting the receiver operating characteristic(ROC)curve and the optimal cutoff value of the NLR was determined by calculating the Youden index(YI).The correlation between CEA,CA199 as well as NLR and clinicopathological parameters was analyzed using the Pearsonx2 test or the Fishier exact probability method.The survival curves and survival rates were calculated by using Kaplan-Meier method,univariate analysis of patient survival was performed using a Log-rank test,in those univariate analysis of P<0.05,using COX regression model for multivariate analysis to evaluation the independent prognostic factors ⑧ P<0.05 was considered the difference to be statistically significant.Summary:1.The relationship between CEA,CA199 as well as NLR and clinicopathological parametersThere was no correlation between preoperative CEA,CA199 as well as NLR and age,sex,tumor size,tumor location,differentiation degree,pathological type,TNM stage,T stage and N stage,P>0.05.However,with the increase of TNM staging,the value of preoperative CEA have a trend to increase(P = 0.085),with the increase of N staging,the value of preoperative CEA also have a trend to increase(P = 0.090).2.Effects of CEA,CA199 as well as NLR on 3-year DFS rate and 5-year OS rate in colorectal cancer patients(1)Univariate analysis showed that the levels of preoperative and postoperative CEA,CA199 as well as NLR were related to 3-year DFS rate and 5-year OS rate in colorectal cancer patients(p<0.05),and TNM staging and N staging were also affected the 3-year DFS rate and 5-year OS rate in colorectal cancer patients(p<0.05).The age,sex,tumor size,tumor location,pathological type and T stage had no effect on 3-year DFS rate and 5-year OS rate in colorectal cancer patients(p>0.05).Treatment was a factor affecting the 3-year DFS rate in colorectal cancer patients(p = 0.019),whereas the degree of differentiation had no effect on 3-year DFS rate in colorectal cancer patients(p = 0.085).The degree of tumor differentiation was associated with 5-year OS related factors in colorectal cancer patients(p = 0.015),had no effect on 3-year DFS rate(p = 0.085).The treatment was a factor affecting the 3-year DFS rate related factors in colorectal cancer patients(p = 0.019),had no effect on 5-year OS rate(p=0.194).(2)Multivariate analysis showed that preoperative and postoperative NLR was an independent prognostic factor for 3-year DFS rate and 5-year OS rate in colorectal cancer patients.In addition,the degree of differentiation is an independent prognostic factor for 5-year OS rate in colorectal cancer patients.3.Effects of CEA,CA199 as well as NLR on 3-year DFS rate and 5-year OS rate in colorectal cancer patients by TNM Staging stratification(1)In the patients with stage Ⅱ,the level of preoperative CEA had no effect on the 3-year DFS rate,P>0.05,there was no statistically difference between the two groups;preoperative high CEA group compared to low CEA group 5-year OS rate was significantly reduced,P=0.024,there was a statistically difference between the two groups.The 3-year DFS rate and 5-year OS rate were significantly reduced in the postoperative high CEA group than those in the low CEA group,the P values were 0.001 and 0.002,respectively,there was a statistically difference between the two groups.The level of preoperative and postoperative CA199 had no effect on the 3-year DFS rate and 5-year OS rate,P>0.05.and there was no statistically difference between the two groups.The 3-year DFS rate and the 5-year OS rate were significantly reduced in the preoperative and postoperative high NLR group than those in the low NLR group,P<0.05,there was a statistically difference between the two groups.(2)In the patients with stage III,the 3-year DFS rate and 5-year OS rate were significantly reduced in the preoperative and postoperative high CEA group,high CA199 group and high NLR group than those in the low CEA group,low CA199 group and low NLR group P<0.05,there was a statistically difference between the two groups·4.Effects of treatment on 3-year DFS rate and 5-year OS rate in colorectal cancer patients by CEA,CA199 and NLR stratification(1)By CEA stratification:Regardless of the level of preoperative CEA,adjuvant chemotherapy had no effect on 3-year DFS rate and 5-year OS rate for patients,P>0.05,however,there was an increasing trend in 3-year DFS rate after adjuvant chemotherapy in patients with preoperative high CEA,P=0.058.The 3-year DFS rate was significantly increased after adjuvant chemotherapy in patients with postoperative high CEA,P=0.018,but did not affect the 5-year OS rate,P>0.05,3-year DFS rate and 5-year OS rate after adjuvant chemotherapy in patients with postoperative low CEA were no significant improvement,P>0.05.(2)By CA199 stratification:The 3-year DFS rate was significantly increased after adjuvant chemotherapy in patients with preoperative high CA199,P = 0.028,but did not affect the 5-year OS rate,P>0.05,3-year DFS rate and 5-year OS rate after adjuvant chemotherapy in patients with preoperative low CA 199 were no significant improvement,P>0.05,there was an increasing trend in 3-year DFS rate after adjuvant chemotherapy in patients with postoperative high CA199,P = 0.071,but did not affect the 5-year OS rate,P>0.05,3-year DFS rate and 5-year OS rate after adjuvant chemotherapy in patients with postoperative low CA199 were no significant improvement,P>0.05.(3)By NLR stratification:The 3-year DFS rate was significantly increased after adjuvant chemotherapy in patients with preoperative high NLR,P= 0.026,but did not affect the 5-year OS rate,P>0.05,3-year DFS rate and 5-year OS rate after adjuvant chemotherapy in patients with preoperative low NLR were no significant improvement,P>0.05.3-year DFS rate and 5-year OS rate were significantly increased after adjuvant chemotherapy in patients with postoperative high NLR,P values were 0.032 and 0.041,respectively,3-year DFS rate and 5-year OS rate after adjuvant chemotherapy in patients with postoperative low NLR were no significant improvement,P>0.05.5.Effects of dynamic changes of CEA,CA199 and NLR on 3-year DFS rate and 5-year OS rate in colorectal cancer patients50 cases of preoperative CEA elevated,24 cases returned to normal after surgery,of which 26 cases are still elevated,the 3-year DFS rate increased from 19.2%to 41.7%and the 5-year OS rate increased from 19.2%to 45.8%in the postoperative low CEA group than those in the high CEA group,P values were 0.256 and 0.052,respectively,there was no statistically difference between the two groups.33 cases of preoperative CA199 elevated,10 cases returned to normal after surgery,of which 23 cases are still elevated,the 3-year DFS rate increased from 26.1%to 40.0%in the postoperative low CA199 group than those in the high CA199 group,P = 0.591,there was no statistically difference between the two groups,the decrease of postoperative CA199 does not affect the 5-year OS rate,P>0.05,there was no statistically difference between the two groups.70 cases of preoperative NLR elevated,33 cases returned to normal after surgery,of which 37 cases are still elevated,the 3-year DFS rate and 5-year OS rate were significantly reduced in the postoperative high NLR group than those in the low NLR group,P values were 0.000,there was a statistically difference between the two groups.Conclusion:1.Understanding the level of CEA contributes to clinical staging and identifing progress for colorectal cancer patients.2.CEA,CA199 and NLR are the prognostic markers of stage Ⅱ and Ⅲ colorectal cancer patients,only NLR is an independent prognostic factor.3.CEA and NLR are both can predict the prognosis of stage Ⅱ and Ⅲ colorectal cancer patients.CA199 may better predict the prognosis of patients with stage Ⅲcolorectal cancer.4.Colorectal cancer patients who have high CEA,high CA199 and high NLR may be more effective to adjuvant chemotherapy.5.Dynamic monitoring of CEA,CA199 and NLR can better predict the prognosis in colorectal cancer patients. |
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