CAR与LCR在Ⅰ~Ⅱ期结直肠癌根治术后预后评估中的价值

Prognostic value of C-reactive protein/albumin ratio and lymphocyte/C-reactive protein ratio in prognostic assessment of patients with stage Ⅰ~Ⅱ colorectal cancer after radical resection

摘要

目的：探讨C反应蛋白/白蛋白比值（CAR）、淋巴细胞/C反应蛋白比值（LCR）在Ⅰ~Ⅱ期结直肠癌根治术后患者预后评估中的价值。方法：选取2021年1月至2023年4月在我院行结直肠癌根治术的204例Ⅰ~Ⅱ期患者为研究对象，术后持续随访2年。根据预后情况将患者分为预后良好组和预后不良组，比较两组患者基础临床特征、肿瘤病情相关特征、治疗相关特征、免疫炎症相关指标等差异。通过多因素Logistic回归分析筛选与Ⅰ~Ⅱ期结直肠癌根治术后预后不良相关的影响因素，采用受试者工作特征（ROC）曲线分析术前CAR、LCR独立及二者联合预测Ⅰ~Ⅱ期结直肠癌根治术后预后的效能。结果：术后2年肿瘤复发31例、肿瘤转移18例、肿瘤相关死亡15例，整体预后不良率为22.5%（46/204）。预后不良组患者年龄、肿瘤长径、低分化占比、临床Ⅱ期占比、术后辅助化疗比例、CRP、CAR均高于预后良好组，白蛋白（ALB）、淋巴细胞计数、LCR均低于预后良好组（P＜0.05）。多因素Logistic回归分析提示肿瘤长径、低分化、临床Ⅱ期、术后辅助化疗、CAR水平较高均是Ⅰ~Ⅱ期结直肠癌根治术不良预后的独立危险因素，LCR水平较高是Ⅰ~Ⅱ期结直肠癌根治术不良预后的独立保护因素（P＜0.05）。校正临床因素后，CAR水平较高（OR=3.054，95%CI：2.186~5.086）是Ⅰ~Ⅱ期结直肠癌根治术不良预后的独立危险因素（P＜0.05），LCR水平较高（OR=0.348，95%CI：0.130~0.592）是Ⅰ~Ⅱ期结直肠癌根治术不良预后的独立保护因素（P＜0.05）。ROC分析提示CAR与LCR联合预测Ⅰ~Ⅱ期结直肠癌根治术不良预后风险的AUC（95%）为0.801（0.722~0.880），效能高于两因素独立预测效能（Z=2.651、2.502，P=0.008、0.010）。结论：CAR值升高、LCR值降低与Ⅰ~Ⅱ期结直肠癌根治术患者预后不良风险增加相关，提示炎症状态和免疫功能对结直肠癌患者的预后具有重要影响，CAR与LCR联合检测对Ⅰ~Ⅱ期结直肠癌根治术患者的预后评估具有一定的临床应用价值。

Abstract

Objective: To explore the value of C-reactive protein/albumin ratio(CAR) and lymphocyte/C-reactive protein ratio(LCR) in the prognosis evaluation of patients with stage Ⅰ~Ⅱ colorectal cancer after radical resection. Methods: This was a prospective observational study. A total of 204 patients with stage Ⅰ~Ⅱ colorectal cancer who underwent radical resection in our hospital from January 2021 to April 2023 were enrolled. All patients were followed up for 2 years postoperatively and divided into good prognosis group and poor prognosis group based on their outcomes. The differences in baseline clinical characteristics, tumor-related features, treatment-related characteristics, and immune-inflammatory indicators between the two groups were compared. Multivariate logistic regression analysis was used to screen the influencing factors associated with poor prognosis in patients with stage Ⅰ~Ⅱ colorectal cancer after radical resection. The receiver operating characteristic(ROC) curve was applied to analyze the efficacy of CAR and LCR alone and in combination for predicting poor prognosis in these patients. Results: Within 2 years postoperatively, 31 patients had tumor recurrence, 18 had tumor metastasis, and 15 died of tumor-related causes, with an overall poor prognosis rate of 22.5%(46/204). Patients in the poor prognosis group had significantly higher age, tumor diameter, proportion of poor differentiation, proportion of clinical stage Ⅱ, rate of postoperative adjuvant chemotherapy, C-reactive protein(CRP), and CAR, while significantly lower albumin(ALB), lymphocyte count, and LCR compared with the good prognosis group(P＜0.05). Multivariate logistic regression analysis showed that larger tumor diameter, poor differentiation, clinical stage Ⅱ, postoperative adjuvant chemotherapy, and higher CAR level were independent risk factors for poor surgical prognosis in stage Ⅰ~Ⅱ colorectal cancer patients, while higher LCR level was an independent protective factor(P＜0.05). After adjusting for clinical factors, higher CAR level[OR(95%CI)=3.054(2.186~5.086)] remained an independent risk factor(P＜0.05), and higher LCR level[OR(95%CI)=0.348(0.130~0.592)] remained an independent protective factor(P＜0.05). ROC analysis indicated that the combined prediction of CAR and LCR for poor surgical prognosis in stage Ⅰ~Ⅱ colorectal cancer patients had an AUC(95%) of 0.801(0.722~0.880), with a higher efficacy than that of the two factors alone(Z=2.651, 2.502, P=0.008, 0.010). Conclusion: Elevated CAR value and decreased LCR value are associated with an increased risk of poor prognosis in patients with stage Ⅰ~Ⅱ colorectal cancer after radical resection, suggesting that inflammatory status and immune function have important impacts on the prognosis of patients with colorectal cancer, and the combined detection of CAR and LCR has certain clinical application value in the prognosis evaluation of patients with stage Ⅰ~Ⅱ colorectal cancer after radical resection.

关键词

结直肠肿瘤 / C反应蛋白/白蛋白 / 淋巴细胞/C反应蛋白 / 预后

Key words

Colorectal neoplasms / C-reactive protein/albumin ratio / Lymphocyte/C-reactive protein ratio / Prognostic

参考文献

[1] 陈志亮， 李天昊， 田红坤， 等 . 美国国立综合癌症网络临床实践指南：结直肠癌（2024）更新解读[J]. 临床外科杂志， 2025， 33（1）： 21-23. DOI: 10.3969/j.issn.1005—6483.20242012.

[2] 中华医学会外科学分会腹腔镜与内镜外科学组， 中华医学会外科学分会结直肠外科学组， 中国医师协会外科医师分会结直肠外科专家工作组， 等 . 腹腔镜结直肠癌根治术操作指南（2023版）[J]. 中华消化外科杂志， 2024， 23（1）： 10-22. DOI: 10.3760/cma.j.cn115610—20231229—00285.

[3] 司红军， 闫齐森， 李纲， 等 . 腹腔镜手术与开腹手术治疗结直肠癌的临床效果评价[J]. 中国现代普通外科进展， 2023， 26（9）： 725—726， 744. DOI: 10.3969/j.issn.1009—9905.2023.09.014.

[4] 郭培源， 胡旭华， 李保坤， 等 . 基于外周血细胞综合评分的结直肠癌患者预后预测模型的构建[J]. 中华胃肠外科杂志， 2024， 27（9）： 953-965. DOI: 10.3760/cma.j.cn441530—20231029—00151.

[5] Mahmoud NN . Colorectal cancer: preoperative evaluation and staging[J]. Surg Oncol Clin N Am, 2022, 31(2): 127-141. DOI: 10.1016/j.soc.2021.12.001.

[6] 陈书仪， 刘小萌， 李欣， 等 . 结直肠癌术后预后不良的危险因素分析及预测模型构建[J]. 医学信息， 2025， 38（3）： 16—20， 25. DOI: 10.3969/j.issn.1006—1959.2025.03.003.

[7] Nakamura Y , Imada A , Fukugaki A , et al. Association of nutritional risk and systemic inflammation with survival in patients with colorectal cancer who underwent curative surgery[J]. Clin Nutr ESPEN, 2022, 49: 417-424. DOI: 10.1016/j.clnesp.2022.03.011.

[8] Bekki T , Shimomura M , Hattori M , et al. C—Reactive protein/albumin ratio is an independent risk factor for recurrence and survival following curative resection of stage i—iii colorectal cancer in older patients[J]. Ann Surg Oncol, 2024, 31(7): 4812-4821. DOI: 10.1245/s10434—024—14961—2.

[9] Takano Y , Kubota A , Kai W , et al. Prognostic value of systemic inflammatory response in lymph node—negative colorectal cancer[J]. Am Surg, 2024, 90(11): 3031-3037. DOI: 10.1177/00031348241262430.

[10] 中华人民共和国国家卫生健康委员会 . 中国结直肠癌诊疗规范（2020版）[J]. 中华消化外科杂志， 2020， 19（6）： 563-588. DOI: 10.3760/cma.j.cn115610—20200504—00348.

[11] Nors J , Iversen LH , Erichsen R , et al. Incidence of recurrence and time to recurrence in stage i to III colorectal cancer: a nationwide Danish cohort study[J]. JAMA Oncol, 2024, 10(1): 54-62. DOI: 10.1001/jamaoncol.2023.5098.

[12] Xu Y , Liang F , Chen Y , et al. Novel model to predict the prognosis of patients with stage ii—iii colon cancer[J]. Biomed Res Int, 2020, 2020: 8812974. DOI: 10.1155/2020/8812974.

[13] Kim ES , Kim SY , Moon A . C—Reactive protein signaling pathways in tumor progression[J]. Biomol Ther (Seoul), 2023, 31(5): 473-483. DOI: 10.4062/biomolther.2023.132.

[14] Hidayat F , Labeda I , Sampetoding S , et al. Correlation of interleukin—6 and C—reactive protein levels in plasma with the stage and differentiation of colorectal cancer: A cross—sectional study in East Indonesia[J]. Ann Med Surg(Lond), 2021, 62: 334-340. DOI: 10.1016/j.amsu.2021.01.013.

[15] Burgos—Molina AM , Téllez Santana T , Redondo M , et al. The crucial role of inflammation and the immune system in colorectal cancer carcinogenesis: a comprehensive perspective[J]. Int J Mol Sci, 2024, 25(11): 6188. DOI: 10.3390/ijms25116188.

[16] Kataoka M , Gomi K , Ichioka K , et al. Clinical impact of C—reactive protein to albumin ratio of the 7th postoperative day on prognosis after laparoscopic colorectal cancer surgery[J]. Ann Coloproctol, 2023, 39(4): 315-325. DOI: 10.3393/ac.2022.00234.0033.

[17] An S , Shim H , Kim K , et al. Pretreatment inflammatory markers predicting treatment outcomes in colorectal cancer[J]. Ann Coloproctol, 2022, 38(2): 97-108. DOI: 10.3393/ac.2021.01004.0143.

[18] Sadrameli S , Bringgold S , Dow—Hillgartner E . Tolerability assessment of tyrosine kinase inhibitors in patients with solid tumor malignancies and hypoalbuminemia[J]. Ann Pharmacother, 2025, 59(6): 521-529. DOI: 10.1177/10600280241284923.

[19] Shukla A , Cloutier M , Appiya Santharam M , et al. The MHC class—I transactivator NLRC5: implications to cancer immunology and potential applications to cancer immunotherapy[J]. Int J Mol Sci, 2021, 22(4): 1964. DOI: 10.3390/ijms22041964.

[20] Azimnasab—Sorkhabi P , Soltani—Asl M , Yoshinaga TT , et al. Indoleamine—2,3 dioxygenase: a fate—changer of the tumor microenvironment[J]. Mol Biol Rep, 2023, 50(7): 6133-6145. DOI: 10.1007/s11033—023—08469—3.

[21] Rajkumari S , Singh J , Agrawal U , et al. Myeloid—derived suppressor cells in cancer: Current knowledge and future perspectives[J]. Int Immunopharmacol, 2024, 142(Pt A): 112949. DOI: 10.1016/j.intimp.2024.112949.

基金资助

河北省2025年度医学科学研究课题计划项目(20251145)