Combined Detection Of NLR And Tumor Markers In The Diagnosis And Treatment Of Colorectal Cancer

ObjectiveBy observing the expression of tumor markers-tumor carcino-embryonic antigen(CEA),carbohydrate antigen 19-9(CA19-9),carbohydrate antigen 72-4(CA72-4)and the ratio of neutrophils to lymphocytes(NLR)in patients with colorectal cancer(CRC),the clinical value of the combined detection of NLR and tumor markers in the diagnosis of CRC was discussed.By studying the changes of serum CEA,CA19-9,CA72-4 and NLR in CRC patients with different stages and pathological classifications,the appropriate combination of detection indicators was selected to improve the clinical sensitivity and specificity of CRC detection,and provide basis for the stage classification,surgical efficacy and prognosis evaluation of CRC.MethodsA total of 179 patients who were admitted to Tai’an City hospital of traditional Chinese medicine from January to December 2017 and pathologically diagnosed as CRC were collected as the patient group.During the same period,107 healthy subjects were examined as normal control group.The clinical data of the patients were collected,including sex,age,and pathological diagnosis results.The expression of serum CEA,CA19-9 and CA72-4 and the changes of NLR in the control group and patient group were detected by electrochemical luminescence immunoassay.The collected clinical data were analyzed by SPSS 20 statistical software.The ROC curve was plotted to obtain the sensitivity and specificity of the four test indexes,and the differences of the sensitivity and specificity of the single test and the combined test were compared.According to different clinicopathologic factors,group analysis and comparison were conducted.The kruskalwallis analysis in rank sum test was used for group comparison.Chi-square test was used for measurement data,and mean ± standard deviation(mean ±SD.)was used for statistical data.P<0.05 was considered statistically significant.Result1 The median values of preoperative CEA,CA19-9,CA72-4 and NLR in patients with colorectal cancer were 3.75 ng/ml,15.89 U/ml,3.34 U/ml and 2.32,which were significantly higher than the normal control group of 1.61 ng/ml,8.54U/ml,1.09U/ml and1.55,the difference was statistically significant(P<0.05).2 ROC curve analysis showed that the area under curve(AUC)of CEA,CA19-9,CA72-4 and NLR in the diagnosis of colorectal cancer were 0.836、0.757、0.728 and 0.756 respectively,95% confidence interval are(0.791-0.881),(0.702-0.813),(0.670-0.786)and(0.700-0.813)respectively.The sensitivity and specificity of CEA in the diagnosis of colorectal cancer are 67% and92.5%,The sensitivity and specificity of CA19-9 in the diagnosis of colorectal cancer are 64% and 83.2%.The sensitivity and specificity of CA72-4 in the diagnosis of colorectal cancer are 86% and 53.3%.The sensitivity and specificity of NLR in the diagnosis of colorectal cancer are 64% and 86.9%.3 The sensitivity and specificity of combined detection of CEA,CA19-9,CA72-4 and NLR in colorectal cancer patients were higher than those in two combined-detection of CEA and CA19-9,CEA and CA72-4,CEA and NLR.4 Changes in CEA,CA19-9,and NLR values were associated with clinical stage,lymph node metastasis,distant metastasis and pathological differentiation in patients with colorectal cancer,not relatedto gender,age,degree of tumor invasion,and degree of tumor invasion.The changes of CA72-4 values were related to the clinical stage,the presence or absence of lymph node metastasis,the presence or absence of distant metastasis,the degree of pathological differentiation,and the size of the tumor.It was not related to the gender,age,and degree of tumor invasion.5 In combination with TNM staging,the higher of the TNM stage,the more obvious the increase of CEA,CA19-9,CA72-4 and NLR,especially in the 4 stage of colorectal cancer,the number of CEA,CA19-9,CA72-4 and NLR increased dramatically,and the values were significantly higher than those in TNM Ⅰ、Ⅱ、Ⅲ.The difference was statistically significant(P<0.05).Conclusion1 The median values of preoperative CEA,CA19-9,CA72-4 and NLR in patients with colorectal cancer were 3.75 ng/ml,15.89 U/ml,3.34 U/ml and 2.32,which were significantly higher than the normal control group of 1.61 ng/ml,8.54U/ml,1.09U/ml and1.55,the difference is statistically significant.2 There is a lack of sensitivity or specificity in a single test.The combination of the 4methods can greatly improve the sensitivity and specificity.Combined detection is more valuable for routine screening of colorectal cancer.3 The expressions of CEA,CA19-9,CA72-4 and NLR were associated with the clinical staging of colorectal cancer,the degree of pathological differentiation,lymph node metastasis,and distal metastasis.Moreover,the change of CEA,CA19-9,CA72-4 and NLR correlated with the TNM stage of colorectal cancer.The higher the TNM stage,the higher the value of CEA,CA19-9,CA72-4 and NLR.SignificanceIn summary,the combined detection of NLR and tumor markers has significantly improved the screening method for clinical CRC,and improved the sensitivity and specificity of the detection.This study confirmed that the expression of NLR and tumor markers was closely related to clinicopathological factors such as tumor TNM stage,which provided theoretical and clinical basis for in-depth understanding of the pathogenesis of CRC and establishment of relatively complete personalized early diagnosis and treatment scheme.