| Part I The impact of metabolic syndrome on the prognosis of colorectal cancerEpidemiological data suggests a close link between metabolic syndrome(MetS)and colorectal cancer(CRC).However,the relationship between MetS and the outcome of CRC is less well understood.We aim to evaluate the impact of MetS on the prognosis in CRC patients.We performed a large cohort study of 1069 CRC patients.The Kaplan-Meier method was used to calculate the cumulative survival rate.Cox proportional hazard regression models were used to analyze the prognosis associated with MetS adjusting for clinicopathologic variables.MetS was identified in 20.7%of the CRC patients.During mean 59.6 months follow-up,patients with MetS had a statistically significantly lower rate of disease-free survival(DFS)than the patients without MetS(P = 0.014).However,there was no difference in overall survival(P = 0.116).Multivariate analysis showed that the presence of MetS was an independent risk factor for DFS(HR = 0.733,95%CI 0.545-0.987,P = 0.041),but not for OS(P = 0.118).MetS is associated with an increased recurrence risk of CRC.Part II Preoperative platelet to lymphocyte ratio is a valuable prognostic biomarker in patients with colorectal cancerRecent studies suggest that an elevated preoperative platelet to lymphocyte ratio(PLR)may be considered a poor prognostic biomarker in patients with colorectal cancer(CRC).The aim of this study was to evaluate the prognostic impact of PLR in patients with CRC.We enrolled 1314 patients who underwent surgery for CRC between 2005 and 2011.Preoperative PLR level was stratified into quintiles for Kaplan-Meier analysis and multivariable Cox proportional hazard regression models.Higher PLR quintiles were significantly associated with poorer overall survival(P =0.002).Multivariate analysis showed that PLR was an independent risk factor for overall survival(OS)(P = 0.034).Patients in PLR quintile 5 had lower overall survival than in quintile 1(hazard ratio(HR)= 1.701,95%confidence interval(CI):1.267-2.282,P<0.001).There was the association of PLR with both the presence and severity of MetS.Elevated preoperative PLR was independently associated with an increased risk of mortality in patients with CRC.The utility of PLR and MetS may help to improve prognostic predictors.Part III The impact of the expression of PD-L1 and FoxP3 on the Prognosis in patients with colorectal cancerThe impact of the expression of PD-L1(programmed death-ligand 1,PD-L1)and FoxP3(forkhead or winged helix transcription factor proteins 3,FoxP3)on the prognosis of colorectal cancer patinets is still controversial.In order to investigate the realtionship of PD-L1 and FoxP3 with colorectal cancer,we analyzed PD-L1 and FoxP3 expression and the prognosis of colorectal cancer,what' more further analyzed the relationsip with metabolism syndrome and platelet to lymphocyte ratio.A total of 151 patients with stage ?,? colorectal cancer were enrolled in this study.Immunohistochemical method was used to analyze the relationship between the expression of PD-L1 and FoxP3 and clinical outcome.The results showed that the rate of high expression of PD-L1 and FoxP3 were 51.6%and 49.0%in colorectal cancer,respectively,Kaplan-Meier analysis indicated that higher PD-L1 and FoxP3 expressions correlated with poorer overall survival(P = 0.026,and P = 0.033 respectively).Multivariate analysis showed that low expression of PD-L1 and FoxP3 was an independent prognostic factor for colorectal cancer(P = 0.002).In the subgroup analysis,the the high expression PD-L1 group had trendence of poorer overall survival in the PLR>150 group and the group without metabolic syndrome(hazard ratios(HR)= 2.227,P = 0.078 and HR =1.723,P~0.085 respectively).The expression of PD-L1 and FoxP3 correlated with the prognosis of colorectal cancer.Application with metabolic status and inflammatory facotor can improve the power of predictive ability of colorectal cancer prognosis. |
PDF Full Text Request