山东医药

目的 基于血常规计算复合炎症指标，分析其与结直肠癌（CRC）患者根治术后短期复发的关系，为临床复发风险识别提供参考依据。方法 纳入行CRC根治术患者210例，根据患者术后2年内随访结果将患者分为复发患者和未复发患者。收集并比较复发与未复发患者的临床资料。采用全自动血细胞分析仪检测患者血常规的中性粒细胞、淋巴细胞、单核细胞和血小板计数，计算并比较患者中性粒细胞/淋巴细胞比值（NLR）、血小板/淋巴细胞比值（PLR）、淋巴细胞/单核细胞比值（LMR）、系统免疫炎症指数（SII）和泛免疫炎症指数（PIV）。通过多因素Logistic回归分析筛选CRC患者根治术后短期复发的独立危险因素，并基于筛选出的外周血炎症指标构建复发风险预测模型。采用受试者工作特征（ROC）曲线及曲线下面积（AUC）评价外周血炎症指标独立及联合预测CRC患者根治术后短期复发的价值。结果 210例患者中2年内共复发60例（28.6%）。短期复发患者肿瘤最大长径、低分化比例、TNM Ⅲ期比例和淋巴结转移比例均高于未复发患者，接受辅助化疗比例、化疗周期数均低于未复发患者（P均<0.05）；短期复发患者NLR、SII和PIV水平均高于未复发患者（P均<0.05）。多因素Logistic回归分析结果显示，NLR、SII和PIV是CRC患者根治术后短期复发的独立危险因素。基于NLR、SII和PIV联合构建的CRC患者根治术后短期复发风险的预测模型AUC为0.809(0.747～0.871)，灵敏度为83.04%、特异度为79.25%，高于NLR单独预测的0.715(0.639～0.791)、80.04%、66.41%;SII单独预测的0.668(0.580～0.756)、75.05%、73.56%和PIV单独预测的0.725(0.651～0.799)、77.45%、72.45%。结论 NLR、SII和PIV升高是CRC患者根治术后短期复发的独立危险因素，联合检测有助于提高对患者短期复发的风险识别。

Objective To investigate the association between composite inflammatory indices derived from complete blood count(CBC) parameters and the risk of short-term recurrence after curative resection in patients with colorectal cancer(CRC), and to provide evidence for the clinical identification of patients at high risk of postoperative recurrence.Methods A total of 210 patients who underwent radical resection for CRC were enrolled.According to the 2-year postoperative follow-up results, the patients were divided into the recurrence and non-recurrence groups.Clinical characteristics were collected and compared between the two groups.Peripheral blood neutrophil, lymphocyte, monocyte, and platelet counts were measured using an automated hematology analyzer.The neutrophil-to-lymphocyte ratio(NLR), platelet-tolymphocyte ratio(PLR), lymphocyte-to-monocyte ratio(LMR), systemic immune-inflammation index(SII), and pan-immune-inflammation value(PIV) were calculated and compared.Multivariate Logistic regression analysis was performed to identify independent risk factors for short-term recurrence after radical resection of CRC.A prediction model was subsequently established based on the identified peripheral blood inflammatory markers.Receiver operating characteristic(ROC) curves and the area under the curve(AUC) were used to evaluate the predictive performance of individual and combined inflammatory markers for short-term postoperative recurrence.Results Among the 210 patients, 60(28.6%) developed recurrence within 2 years after surgery.Compared with the non-recurrence group, patients with recurrence had a larger maximum tumor diameter, higher proportions of poorly differentiated tumors, TNM stage Ⅲ disease, and lymph node metastasis, whereas the proportion receiving adjuvant chemotherapy and the number of chemotherapy cycles were significantly lower(all P<0.05).The levels of NLR, SII, and PIV were significantly higher in the recurrence group than in the non-recurrence group(all P<0.05).Multivariate Logistic regression analysis identified elevated NLR, SII, and PIV as independent risk factors for short-term recurrence after radical resection of CRC.The prediction model combining NLR, SII, and PIV achieved an AUC of 0.809(95% CI: 0.747-0.871), with a sensitivity of 83.04% and a specificity of 79.25%, outperforming NLR alone [0.715(0.639-0.791), 80.04%, 66.41%], SII alone [0.668(0.580-0.756), 75.05%, 73.56%], and PIV alone [0.725(0.651-0.799), 77.45%, 72.45%].Conclusions Elevated NLR, SII, and PIV are independent risk factors for short-term recurrence after radical resection of CRC.Combined assessment of these inflammatory markers may improve the identification of patients at high risk for short-term postoperative recurrence.