Lymphocyte-to-monocyte ratio effectively predicts survival outcome of patients with obstructive colorectal cancer
| Autor: | Xian-qiang Chen, Ping Hou, Bing-qiang Lin, Chao-Rong Xue, Jun-rong Zhang |
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| Rok vydání: | 2019 |
| Předmět: |
Male
Colorectal cancer Lymphocyte medicine.medical_treatment Inflammation indexes Self-expanding metal stent insertion as a bridge to surgery Kaplan-Meier Estimate Gastroenterology Monocytes Leukocyte Count 0302 clinical medicine Risk Factors Lymphocytes Lymph node General Medicine Middle Aged Decompression Surgical Prognosis medicine.anatomical_structure Elective Surgical Procedures 030220 oncology & carcinogenesis Preoperative Period Emergency surgery Biomarker (medicine) 030211 gastroenterology & hepatology Female Colorectal Neoplasms Adult medicine.medical_specialty Self Expandable Metallic Stents Disease-Free Survival 03 medical and health sciences Retrospective Study Internal medicine Obstructive colorectal cancers medicine Humans Risk factor Emergency Treatment Aged Receiver operating characteristic Proportional hazards model business.industry Patient Selection Stent medicine.disease ROC Curve business Intestinal Obstruction |
| Zdroj: | World Journal of Gastroenterology |
| ISSN: | 2219-2840 |
| Popis: | BACKGROUND Obstructive colorectal cancer (OCC) is always accompanied by severe complications, and the optimal strategy for patients with OCC remains undetermined. Different from emergency surgery (ES), self-expandable metal stents (SEMS) as a bridge to surgery (BTS), could increase the likelihood of primary anastomosis. However, the stent failure and related complications might give rise to a high recurrence rate. Few studies have focused on the indications for either method, and the relationship between preoperative inflammation indexes and the prognosis of OCC is still underestimated. AIM To explore the indications for ES and BTS in OCCs based on preoperative inflammation indexes. METHODS One hundred and twenty-eight patients who underwent ES or BTS from 2008 to 2015 were enrolled. Receiver operating characteristic (ROC) curve analysis was used to define the optimal preoperative inflammation index and its cutoff point. Kaplan-Meier analyses and Cox proportional hazards models were applied to assess the association between the preoperative inflammation indexes and the survival outcomes [overall survival (OS) and disease-free survival (DFS)]. Stratification analysis was performed to identify the subgroups that would benefit from ES or BTS. RESULTS OS and DFS were comparable between the ES and BTS groups (P > 0.05). ROC curve analysis showed derived neutrophil-to-lymphocyte ratio (dNLR) as the optimal biomarker for the prediction of DFS in ES (P < 0.05). Lymphocyte-to-monocyte ratio (LMR) was recommended for BTS with regard to OS and DFS (P < 0.05). dNLR was related to stoma construction (P = 0.001), pneumonia (P = 0.054), and DFS (P = 0.009) in ES. LMR was closely related to lymph node invasion (LVI) (P = 0.009), OS (P = 0.020), and DFS (P = 0.046) in the BTS group. dNLR was an independent risk factor for ES in both OS (P = 0.032) and DFS (P = 0.016). LMR affected OS (P = 0.053) and DFS (P = 0.052) in the BTS group. LMR could differentiate the OS between the ES and BTS groups (P < 0.05). CONCLUSION Preoperative dNLR and LMR could predict OS and DFS in patients undergoing ES and BTS, respectively. For OCC, as the potential benefit group, patients with a low LMR might be preferred for BTS via SEMS insertion. |
| Databáze: | OpenAIRE |
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