Clinical Study Of Predicting The Prognosis Of Colorectal Cancer Patients Based On Preoperative NLR And NHR

Objective: Based on preoperative Neutrophil to lymphocyte ratio(NLR)and Neutrophil to high density lipoprotein ratio(NHR)to analyze and explore the risk factors affecting the prognosis of patients with colorectal cancer,establish prognostic nomogram model and evaluate.Methods: Clinical data of patients who were pathologically diagnosed with colorectal cancer and received radical surgical treatment in the Department of General Surgery,the Second Hospital of Lanzhou University from March 2018 to May 2019 were collected.A total of 160 patients were finally enrolled after screening according to the inclusion and exclusion criteria.Follow-up was conducted by telephone,inpatient and outpatient reexamination,etc.Another 137 patients with colorectal polyp/adenoma were set up as controls.First,the baseline difference of NLR and NHR in colorectal cancer group and colorectal polyp/adenoma group was determined.Then,the Receiver operating characteristic(ROC)curve was drawn according to the survival of colorectal cancer patients,and the optimal cut-off values of NLR and NHR were obtained.Analysis respectively with the age,sex,albumin,total bilirubin,total cholesterol,CEA and CA19-9,Ki67 protein,tumor site,tumor diameter,shape of tumor,pathologic type,differentiation degree,infiltration layers neural/vascular invasion,lymph node invasion and clinical pathological features,and risk factors of univariate and multivariate analysis.Overall survival(OS)and Disease-free survival(DFS)were compared in NLR and NHR groups with high and low values.Finally,according to the results of multi-factor risk factor screening,the nomogram models of OS and DFS were further constructed.Then,the accuracy and practicability of the model were evaluated by discrimination evaluation,consistency analysis and decision curve analysis respectively,and the nomogram of webpage was established.Results:1.Comparison of baseline levels: baseline levels of NLR and NHR in colorectal cancer group were significantly higher than those in colorectal polyp/adenoma group,with statistical differences between them(all P<0.01).2.ROC curve and cutoff value: the area under ROC curve corresponding to NLR and NHR was 0.718 and 0.782(all P<0.001),and the corresponding optimal cutoff value was 3.26 and 2.95,respectively.3.Analysis of clinicopathologic features: NLR was statistically significant with tumor site(P=0.002);NHR was statistically significant with total cholesterol(P=0.04)and Ki67 protein(P=0.042).4.Univariate and multivariate analysis: In OS,univariate analysis showed that CEA(P=0.006),NLR(P<0.001),NHR(P<0.001),tumor site(P=0.008)and degree of differentiation(P<0.05)were statistically different from OS.Multivariate analysis showed that CEA(P<0.05),NLR(P=0.001)and NHR(P<0.001)were independent risk factors for OS.In DFS,univariate analysis showed that CEA(P=0.018),CA19-9(P=0.006),NLR(P=0.031),NHR(P=0.007),lymph node invasion(P=0.005)and nerve/vascular invasion(P=0.003)were statistically different from DFS.Multivariate analysis showed that only NHR(P=0.007)and lymph node invasion(P=0.023)were independent risk factors for DFS.5.Survival analysis of NLR and NHR groups: 3 years of OS and DFS in low and high NLR groups were 79.4% and 41.5%(P<0.001),and 75.4% and 60.4%(P=0.028),respectively.3 years of OS and DFS in low and high NHR groups were 92.1% and50.5%(P<0.001),and 82.5% and 62.4%(P=0.005)respectively.6.Construction and evaluation of nomogram model: Nomogram models based on NLR and NHR have better efficacy in predicting the survival and recurrence of colorectal cancer patients for more than 1 year(long-term).The differentiation evaluation,consistency analysis and decision curve analysis all support the above,and the web nomogram runs well.Conclusion: Preoperative NLR and NHR are significantly different between colorectal polyps/adenomas and cancers,and high NLR and NHR are often associated with poor prognosis.The prediction nomogram model built around NLR and NHR is of great significance in the long-term prognosis assessment of colorectal cancer patients.This model integrates the effects of "inflammation","immunity" and "cholesterol metabolism" on the behavioral characteristics of malignant tumors,and is more comprehensive and balanced in the prognosis assessment of patients with colorectal cancer.