AGR、PLR及NLR变化与转移性结直肠癌化疗疗效的相关性研究

摘要/Abstract

摘要：

目的探讨白蛋白-球蛋白比值（AGR）、血小板-淋巴细胞比值（PLR）、中性粒细胞-淋巴细胞比值（NLR）与转移性结直肠癌（mCRC）患者化疗疗效的相关性。方法选取2016年1月至2020年 9月就诊于山西医科大学第一医院行化疗的107例mCRC患者的临床资料,收集化疗前及化疗3周期后AGR、NLR及PLR值进行回顾性分析;3周期后根据疗效评价将患者分为3组：部分缓解（PR）组、病情稳定（SD）组、疾病进展（PD）组,分析各组化疗前后AGR、PLR及NLR值的变化及变化程度与疗效的关系。结果PR组18例,SD组53例,PD组36例,3组间年龄、性别、远处转移部位、肿瘤部位、T分期、N分期的差异均无统计学意义（F=0.33,P=0.721;χ²=2.94,P=0.230;χ²=2.34,P=0.674;χ²=0.80,P=0.669;χ²=5.68,P=0.224;χ²=2.06,P=0.375）。PR组患者化疗前AGR、PLR及NLR值分别为1.57±0.19、180.05±102.77、5.19（4.50,5.83）,化疗后分别为1.45±0.23、115.81±55.79、1.83（1.06,2.84）,差异均具有统计学意义（t=2.32,P=0.033;t=2.84,P=0.011;Z=-2.94,P=0.003）;SD组患者化疗前AGR、PLR及NLR值分别为1.66（1.40,1.77）、158.18（103.81,236.26）、2.41（1.75,4.07）,化疗后AGR、PLR及NLR值分别为1.35（1.15,1.60）、123.85（94.86,176.44）、1.49（1.27,2.33）,差异均具有统计学意义（Z=-4.51,P<0.001;Z=-3.31,P=0.001;Z=-3.90,P<0.001）;PD组患者化疗前AGR、PLR及NLR值分别为1.60（1.48,1.87）、122.07（77.14,175.72）、2.37（1.28,4.20）,化疗后AGR、PLR及NLR值分别为1.26（1.08,1.40）、176.39（139.89,280.64）、4.71（3.71,6.96）,差异均具有统计学意义（Z=-4.49,P<0.001;Z=-3.42,P=0.001;Z=-4.18,P<0.001）。化疗前后AGR差值（OR=3.66,95%CI为1.29~10.39,P=0.015）、PLR差值（OR=0.99,95%CI为0.99~1.00,P<0.001）及NLR差值（OR=0.59,95%CI为0.49~0.70,P<0.001）与临床疗效相关,AGR差值越大,近期疗效越差;PLR及NLR差值越大,近期疗效越好。治疗前后AGR、PLR及NLR的变化值与临床疗效的相关性由大到小排序为Δ_NLR>Δ_PLR>Δ_AGR（r=-0.68,P<0.001;r=-0.51,P<0.001;r=0.25,P=0.009）。结论化疗前后AGR、NLR、PLR水平变化与mCRC患者的近期疗效相关,对于患者疗效监测及治疗方案的进一步优选有一定意义。

关键词:结直肠肿瘤,白蛋白-球蛋白比值,血小板-淋巴细胞比值,中性粒细胞-淋巴细胞比值

Abstract:

ObjectiveTo investigate the correlations between albumin globulin ratio （AGR）, platelet lymphocyte ratio （PLR）, neutrophil lymphocyte ratio （NLR） and efficacy of chemotherapy for patients with metastatic colorectal cancer （mCRC）.MethodsThe clinical data of 107 mCRC patients who were treated at the First Hospital of Shanxi Medical University for chemotherapy from January 2016 to September 2020 were selected, and the values of AGR, NLR and PLR before chemotherapy and after 3 cycles of chemotherapy were collected for retrospective analysis. After 3 cycles, patients were divided into three groups according to efficacy evaluation： partial response （PR） group, stable disease （SD） group and progressive disease （PD） group. The changes of AGR, PLR and NLR values before and after chemotherapy, and the relationships between the degrees of changes and the therapeutic effects were analyzed.ResultsThere were 18 cases in the PR group, 53 cases in the SD group and 36 cases in the PD group. There were no significant differences in age, sex, distant metastasis site, cancer site, T stage and N stage among the three groups （F=0.33,P=0.721;χ²=2.94,P=0.230;χ²=2.34,P=0.674;χ²=0.80,P=0.669;χ²=5.68,P=0.224;χ²=2.06,P=0.375）. The AGR, PLR and NLR values before chemotherapy in the PR group were 1.57±0.19, 180.05±102.77 and 5.19 （4.50, 5.83）, and they were 1.45±0.23, 115.81±55.79 and 1.83 （1.06, 2.84） after chemotherapy, with statistically significant differences （t=2.32,P=0.033;t=2.84,P=0.011;Z=-2.94,P=0.003）. In the SD group, AGR, PLR and NLR values before chemotherapy were 1.66 （1.40, 1.77）, 158.18 （103.81, 236.26）, 2.41 （1.75, 4.07）, and they were 1.35 （1.15,1.60）, 123.85 （94.86, 176.44）, 1.49 （1.27, 2.33） after chemotherapy, with statistically significant differences （Z=-4.51,P<0.001;Z=-3.31,P=0.001;Z=-3.90,P<0.001）. The AGR, PLR and NLR values in the PD group before chemotherapy were 1.60 （1.48, 1.87）, 122.07 （77.14, 175.72）, 2.37 （1.28, 4.20）, and they were 1.26 （1.08,1.40）, 176.39 （139.89, 280.64） and 4.71 （3.71, 6.96） after chemotherapy, with statistically significant differences （Z=-4.49,P<0.001;Z=-3.42,P=0.001;Z=-4.18,P<0.001）. The differences in AGR （OR=3.66, 95%CI： 1.29-10.39,P=0.015）, PLR （OR=0.99, 95%CI： 0.99-1.00,P<0.001） and NLR （OR=0.59, 95%CI： 0.49-0.70,P<0.001） before and after chemotherapy were related to clinical efficacy. The greater the difference of AGR, the worse the short-term efficacy. The greater the difference of PLR and NLR, the better the short-term efficacy. The correlation between the changes in AGR, PLR and NLR before and after treatment and the clinical efficacy was sorted in descending order Δ_NLR>Δ_PLR>Δ_AGR（r=-0.68,P<0.001;r=-0.51,P<0.001;r=0.25,P=0.009）.ConclusionThe changes in the levels of AGR, NLR and PLR before and after chemotherapy are correlated with the short-term efficacy of mCRC, and it has certain significance for monitoring the curative effects of patients and further optimizing the treatment plan.

Key words:Colorectal neoplasms,Albumin globulin ratio,Platelet lymphocyte ratio,Neutrophil lymphocyte ratio

赵莹, 张革红. AGR、PLR及NLR变化与转移性结直肠癌化疗疗效的相关性研究[J]. 国际肿瘤学杂志, 2022, 49(8): 473-477.

Zhao Ying, Zhang Gehong. Study on the correlations between AGR, PLR and NLR changes and chemotherapy efficacy of metastatic colorectal cancer[J]. Journal of International Oncology, 2022, 49(8): 473-477.

图/表3

表1

107例转移性结直肠癌患者一般资料与化疗疗效的关系（$\bar{x}±s$/例）"

一般资料	PR组（n=18）	SD组（n=53）	PD组（n=36）	F/χ²值	P值
年龄（岁）	63.50±8.65	60.93±11.17	61.33±13.72	0.33	0.721
性别
男	10	28	13	2.94	0.230
女	8	25	23	2.94	0.230
远处转移部位
肺转移	2	13	8	2.34	0.674
肝转移	12	25	19
其他	4	15	9
肿瘤部位
结肠癌	13	34	26	0.80	0.669
直肠癌	5	19	10	0.80	0.669
T分期
T₁或T₂	4	19	7	5.68	0.224
T₃	10	17	14
T₄	4	17	15
N分期
N₀或N₁	10	25	13	2.06	0.375
N₂	8	28	23	2.06	0.375

表1

表2

不同疗效的转移性结直肠癌患者化疗前后AGR、PLR及NLR水平变化[$\bar{x}±s$/M（Q1,Q3）]"

组别	AGR	PLR	NLR
PR组（n=18）
化疗前	1.57±0.19	180.05±102.77	5.19（4.50,5.83）
化疗后	1.45±0.23	115.81±55.79	1.83（1.06,2.84）
t/Z值	2.32	2.84	-2.94
P值	0.033	0.011	0.003
SD组（n=53）
化疗前	1.66（1.40,1.77）	158.18（103.81,236.26）	2.41（1.75,4.07）
化疗后	1.35（1.15,1.60）	123.85（94.86,176.44）	1.49（1.27,2.33）
Z值	-4.51	-3.31	-3.90
P值	<0.001	0.001	<0.001
PD组（n=36）
化疗前	1.60（1.48,1.87）	122.07（77.14,175.72）	2.37（1.28,4.20）
化疗后	1.26（1.08,1.40）	176.39（139.89,280.64）	4.71（3.71,6.96）
Z值	-4.49	-3.42	-4.18
P值	<0.001	0.001	<0.001

表2

指标	β值	SE值	Wald值	OR值	95%CI	P值
Δ_AGR	1.30	0.53	5.95	3.66	1.29~10.39	0.015
Δ_PLR	-0.01	0.00	15.65	0.99	0.99~1.00	<0.001
Δ_NLR	-0.54	0.09	32.69	0.59	0.49~0.70	<0.001

表3

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