| Objective: Plasma fibrinogen is closely associated with the immune system’s inflammatory response,and it plays a crucial role in tumor development.Several studies have demonstrated that the F-NLR,F-PLR and F-MLR scores of preoperative plasma fibrinogen(Fbg)combined with inflammation-related markers,namely NLR(neutrophil-to-lymphocyte ratio),PLR(platelet-to-lymphocyte ratio),and MLR(monocyte-to-lymphocyte ratio),are correlated with postoperative pathological characteristics and prognosis of a variety of malignant tumor patients.In recent years,several studies have confirmed that a stratified nomogram designed by R software can provide better prognostic judgments for malignant tumors.However,there are currently no studies on nomogram models based on preoperative plasma fibrinogen,inflammation-related markers,and postoperative pathological features in colorectal cancer.Thus,this study aims to screen the most valuable indicators related to prognosis from the F-NLR,F-PLR,and F-MLR scores of plasma fibrinogen combined with inflammation-related markers and to develop a nomogram model related to the prognosis of colorectal cancer patients using R software.Internal validation will be performed to provide clinicians with accurate prognostic judgments and to guide postoperative interventions and health education for patients.Part Ⅰ: Relationship between preoperative plasma fibrinogen and inflammation-related markers constructed by F-NLR,F-PLR,and F-MLR scores and clinicopathological features and prognosisMethods: This study conducted a retrospective analysis of 615 patients with colorectal cancer who underwent radical surgery at the Western Theater General Hospital from January 2017 to July 2019.Routine preoperative hematological tests were collected from patients after admission to the hospital,and the NLR,PLR,and MLR were calculated.The scores(F-NLR,F-PLR,F-MLR)were constructed by combining Fbg with NLR,PLR and MLR respectively,based on the optimal cut-off values obtained from ROC curve calculation.The relationship between different scores and postoperative pathological characteristics and prognosis of colorectal cancer patients was analyzed.At the same time,Optimal prognostic values were screened from F-NLR,F-PLR,and F-MLR scores constructed by plasma fibrinogen combined with inflammation-related markers.Results: The analysis of the relationship between the scores of preoperative fibrinogen combined with inflammation-related markers and the pathological characteristics of colorectal cancer showed that there were statistically significant differences between F-NLR scores and gender,tumor location,CEA level,T stage,and whether nerve invasion(P<0.05).Statistically significant differences were observed between F-PLR scores and tumor location,CEA level,and T stage(P<0.05).There were statistically significant differences between F-MLR scores and gender,age,tumor location,CEA level,CA199 level,T stage and whether nerve invasion(P<0.05).Mono-factor Cox regression analysis showed that CEA level,CA199 level,degree of differentiation,whether nerve invasion,whether vascular invasion,TNM stage,F-NLR score,F-PLR score,and F-MLR score were risk factors affecting postoperative DFS and OS in patients with colorectal cancer(P<0.05).Multi-factor Cox regression analysis showed that F-MLR score was an independent risk factor for postoperative DFS and OS in colorectal cancer(P<0.05),while F-NLR and F-PLR were not independent risk factors affecting the prognosis of CRC patients(P<0.05).Kaplan-Meier survival analysis and log-rank test analysis showed that F-NLR score,F-PLR score,and F-MLR score were risk factors affecting DFS and OS of colorectal cancer(P<0.05),and the survival time and survival rate of CRC patients with higher F-MLR score were lower than F-NLR and F-PLR.Conclusion: 1.The F-NLR,F-PLR and F-MLR scores of preoperative detection of fibrinogen in combination with NLR,PLR,and MLR are reliable clinical indices that help to judge the prognosis of colorectal cancer patients.2.The F-MLR score is a reliable indicator for determining the prognosis of colorectal cancer and is better than F-NLR and F-PLR in determining the prognosis of colorectal cancer patients Part Ⅱ: Prognostic value research of nomograph model based on F-MLR score and postoperative pathological featuresMethods: We conducted a retrospective analysis of 615 patients who diagnosed with colorectal cancer and underwent radical surgery from January2017 to July 2019 at the Western Theater General Hospital.The patients were randomly divided into training set(N=430)and validation set(N=185)at a ratio of 7:3.We also screened for the optimal prognostic value from the F-NLR,F-PLR,and F-MLR scores constructed by plasma fibrinogen combined with inflammation-related markers.We use mono-factor and multi-factor Cox regression analysis to determine the risk factors associated with prognosis,and construct a nomograph model using R software.We performed internal validation and evaluated the prediction accuracy of the nomogram model using the C-index,calibration curve,and ROC curve.Results: We found no statistically significant differences in the 11 variables of gender,age,tumor location,CEA level,CA199 level,whether nerve invasion,whether vascular invasion,TNM stage,F-NLR score,F-PLR score,and F-MLR score between the training and validation sets(P>0.05).Through univariate and multifactor Cox regression analysis in the training and validation sets,we identified the F-MLR score,CEA level,degree of tumor differentiation and TNM stage as independent risk factors affecting the prognosis of CRC patients(P<0.05).We constructed a nomograph model based on four factors.And the C-index index,calibration curves,and ROC curves showed that the nomograph model had good accuracy in predicting OS.Conclusion: Our nomograph model based on the combination of F-MLR scores with clinical and pathological characteristics showed superior in predicting the prognosis of CRC patients.It can serve as a valuable tool for clinicians in guiding patient health education and postoperative interventions. |
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