2025 年第 2 期 第 20 卷

外周血相关指标联合检测对结直肠癌患者根治性切除术后3年生存情况的预测价值

Predictive value of combined detection of peripheral blood related indicators on 3-year survival of patients with colorectal cancer after radical resection

作者：任拾璞1李云霞2朱增强1李雯1王玉斌1

英文作者：Ren Shipu1 Li Yunxia2 Zhu Zengqiang1 Li Wen1 Wang Yubin1

单位：1兰州石化总医院甘肃中医药大学第四附属医院肿瘤血液科，兰州730060；2兰州石化总医院甘肃中医药大学第四附属医院肿瘤内科，兰州730060

英文单位：1Department of Oncology and Hematology Fourth Affiliated Hospital of Gansu University of Chinese Medicine Lanzhou Petrochemical General Hospital Lanzhou 730060 China; 2Department of Oncology Fourth Affiliated Hospital of Gansu University of Chinese Medicine Lanzhou Petrochemical General Hospital Lanzhou 730060 China

关键词：结直肠癌；根治性切除术；循环肿瘤DNA；红细胞体积分布宽度/血小板计数比值；中性粒细胞/淋巴细胞比值；生存；预测

英文关键词：olorectalcancer;Radicalresection;CirculatingtumorDNA;Redbloodcellvolumedistributionwidthtoplateletcountratio;Neutrophiltolymphocyteratio;Survival;Prediction

• 摘要：

• 目的 探讨术前外周血循环肿瘤DNA（ctDNA）、红细胞体积分布宽度/血小板计数比值（RPR）、中性粒细胞/淋巴细胞比值（NLR）联合检测对结直肠癌患者根治性切除术后3年生存情况的预测价值。方法 选取2020年3月至2021年3月在兰州石化总医院进行结直肠癌根治性切除术的114例患者作为结直肠癌组。选择同期在本院体检健康的志愿者114名作为对照组。检测计算外周血ctDNA、RPR、NLR水平。对所有结直肠癌患者根治性切除术后进行3年生存情况的随访，依据生存情况分为死亡组和生存组。Kaplan-Meier法分析外周血ctDNA、RPR、NLR水平与结直肠癌患者根治性切除术后3年生存情况的关系；采用受试者工作特征曲线分析外周血ctDNA、RPR、NLR联合检测对结直肠癌患者根治性切除术后3年生存情况的预测价值。结果 结直肠癌组患者外周血ctDNA、RPR、NLR水平均显著高于对照组（均P＜0.001）。外周血ctDNA、RPR、NLR水平与TNM分期、分化程度、淋巴结转移、癌胚抗原水平有关（均P＜0.05）。本研究死亡40例（死亡组）、生存74例（生存组），死亡组患者外周血ctDNA、RPR、NLR水平均显著高于生存组［（98±12）μg/L比（79±12）μg/L、（0.19±0.05）比（0.14±0.04）、（2.8±0.4）比（2.1±0.5）］（t=8.221、5.825、7.384，均P＜0.001）。ctDNA、RPR、NLR高水平组患者3年内生存率低于低水平组（均P＜0.05）。外周血ctDNA、RPR、NLR联合检测对结直肠癌患者根治性切除术后3年生存情况预测的受试者工作特征曲线下面积显著大于ctDNA、RPR、NLR单独检测（均P<0.05）。结论 ctDNA、RPR、NLR联合可作为结直肠癌患者根治性切除术后生存情况的预测指标。

• Objective To investigate the predictive value of preoperative circulating tumor DNA (ctDNA), red blood cell volume distribution width to platelet ratio (RPR) and neutrophil to lymphocyte ratio (NLR) in 3-year survival of patients with colorectal cancer after radical resection. Methods A total of 114 patients who underwent radical resection of colorectal cancer in Lanzhou Petrochemical General Hospital from March 2020 to March 2021 were selected as the colorectal cancer group. A total of 114 healthy volunteers were selected as the control group. The levels of ctDNA, RPR and NLR in peripheral blood were detected and calculated. All patients with colorectal cancer were followed up for 3 years after radical resection, and were divided into death group and survival group according to survival situation. The Kaplan-Meier method was used to analyze the relationship between the levels of ctDNA, RPR and NLR in peripheral blood and the 3-year survival of patients with colorectal cancer after radical resection. The receiver operating characteristic curve was used to analyze the predictive value of the combined detection of ctDNA, RPR and NLR in peripheral blood for the 3-year survival of patients with colorectal cancer after radical resection. Results The levels of ctDNA, RPR, and NLR in peripheral blood of patients with colorectal cancer were significantly higher than those in the control group (all P<0.001). The levels of ctDNA, RPR and NLR in peripheral blood are related to TNM stage, differentiation degree, lymph node metastasis and carcinoembryonic antigen level (all P<0.05). In this study, 40 patients died (death group) and 74 patients survived (survival group). The levels of ctDNA, RPR and NLR in peripheral blood of patients in the death group were significantly higher than those in the survival group ［(98±12)μg/L vs (79±12)μg/L, (0.19±0.05) vs (0.14±0.04), (2.8±0.4) vs (2.1±0.5)］(t=8.221, 5.825, 7.384, all P<0.001). The 3-year survival rates of patients in the high level group of ctDNA, RPR and NLR were lower than those in the low level group (all P<0.05). The area under the receiver operating characteristic curve of the combined detection of ctDNA, RPR and NLR in predicting the 3-year survival of patients with colorectal cancer after radical resection was significantly larger than that of ctDNA, RPR and NLR alone (all P<0.05）. Conclusion The combination of ctDNA, RPR and NLR can be used as a predictor of survival in patients with colorectal cancer after radical resection.